A handful of people opposed to Amendment 3 protested outside the Missouri Supreme Court on Tuesday, Sept. 10, 2024, following a ruling to keep the abortion amendment on the Nov. 5 ballot (Anna Spoerre/Missouri Independent).

The family business that owns the Kansas City Chiefs is one of the biggest funders of a political action committee opposing a proposed amendment to overturn Missouri’s abortion ban. 

Unity Hunt, the business that controls the assets of the late Lamar Hunt, including the Chiefs, in late September donated $300,000 to the Leadership for America PAC. It is currently running ads on several conservative radio stations across the state opposing the abortion-rights amendment, which will appear on the November ballot as Amendment 3. 

Leadership for America is an independent spending PAC created in January. Prior to receiving the donation from Unity Hunt, the PAC had $31,159 on hand.

Along with paying directly for radio ads, Leadership for America has donated $100,000 to Vote “No” on 3, the main opposition group in the Amendment 3 campaign. And on Oct. 3, the PAC donated $100,000 to a PAC called Missouri Leadership Fund, which gave $100,000 to Vote “No” on 3 six days later.

A spokesperson for the team said Friday that the donation came directly from Lamar Hunt Jr., and not from the Chiefs team.

Unity Hunt did not respond to requests for comment.

No one from Leadership for America could be reached for comment. The telephone number given to the Missouri Ethics Commission for treasurer John Royal has been disconnected.

The ads, which began airing across the state on Monday, call Amendment 3 “cleverly-worded to convince you that it only allows abortions until fetal viability.” 

“But it has loopholes that allow for abortions through all nine months of pregnancy,” the ad continues. “Abortion proponents used to say ‘safe, legal and rare.’ But now they want abortion as common as the morning after pill.”

Supporters of the amendment say claims of abortions in the third trimester are misleading, since the legal freedoms around abortion would only apply until fetal viability, which is generally considered to be around 24 weeks, according to the American College of Obstetricians and Gynecologists.

The amendment text would allow the Missouri legislature to regulate abortion after fetal viability with exceptions only to “protect the life, or physical or mental health of the pregnant person.”

Abortion is illegal from the moment of conception in Missouri, with limited exceptions for medical emergencies. There are no exceptions for victims of rape or incest. 

Failed GOP attempt to keep abortion off Missouri ballot could foreshadow fight to come

Leadership for America has spent a little more than $32,000 on the radio ads, which are set to run through Nov. 4. There are no other broadcast ads opposing the amendment.  

Organized efforts against Amendment 3 have been hugely outspent by Missourians for Constitutional Freedom, the committee backing the amendment. The campaign reported spending $7.3 million through June 30 and has purchased more than $8.7 million in television ads since the start of September.

Vote “No” on 3 has not filed a full disclosure report but has amassed $870,000 in donations greater than $5,000 since Aug. 30.

While the content of the Leadership for America ad aligns with most other opposition talking points, the original source of the money behind the ad drew some attention. 

“It is incredibly disappointing to see Unity Hunt spend resources on this campaign to spread lies and continue the fear-mongering surrounding Amendment 3,” said state Rep. Maggie Nurrenbern, a Democrat from Kansas City. 

Nurrenbern, who is running for the 17th Senate District in Clay County, said she was particularly alarmed by the size of the donation from a family she said “has done so much good for Kansas City and the Kansas City area.” 

State Rep. Ashley Aune, also a Democrat from Kansas City, said she wasn’t surprised to see the Hunt family backing an effort to stop abortion.

“But also, it’s disappointing because when you have such a big platform,” Aune said. “Using that platform to sow misinformation is a really irresponsible way to use it.”

In 2020, Lamar Hunt Jr. served as the master of ceremonies at the Kansans for Life annual Valentine’s Day banquet. 

Hunt, an owner of the Chiefs, told the crowd: “I do not think it is a cliché to say we are in a life and death battle for the truth and authentic dignity of the human person.” 

Hunt six years earlier published a blog post to his website contemplating what he observed as cultural shifts away from the “pro-choice” movement, comparing the momentum in the “pro-life” community to the San Francisco 49ers comeback and near-win in the final seconds of the 2013 Super Bowl.

This story was updated at 3:20 p.m. Friday to include a comment from a Kansas City Chiefs spokesperson.

The Planned Parenthood clinic in St. Louis on June 24, 2022 (Tessa Weinberg/Missouri Independent).

Three Planned Parenthood clinics in eastern and southern Missouri will shut their doors next month, though the organization’s leaders insist the moves will ultimately expand access to reproductive health care. 

As part of the consolidation effort, Planned Parenthood Great Rivers will be expanding telehealth services and hours at its remaining St. Louis clinics. 

The moves come as the state has successfully implemented legislation cutting Planned Parenthood clinics off from Medicaid funding, though the organization’s leadership says the closures are not related to the new law. 

They are also taking place as Missourians are set to vote on whether to enshrine abortion rights in the state constitution, a decision that could radically expand access to reproductive health care around the state.

Failed GOP attempt to keep abortion off Missouri ballot could foreshadow fight to come

On Nov. 1, the Florissant health center in North St. Louis County and the South Grand Health Center just south of downtown St. Louis will close. 

On Jan. 1, the health center in Joplin will also close. No staff members are being laid off as part of the restructuring, Planned Parenthood said in a press release.

Richard Muniz, interim president and CEO of Planned Parenthood Great Rivers, said patient care can be transferred to other Planned Parenthood locations. He said the goal is to increase virtual care access and get patients in touch with providers sooner, and then into appointments more quickly.

“The operational changes we’re announcing will ensure that we’re here for our patients not just today, tomorrow, but for the next 90 years,” Muniz said in a statement. “Our patients are our top priority, and despite repeated attacks from politicians, our commitment never wavers. We’re going to be here for them no matter what.”

For Joplin patients, transportation will be provided to the Springfield clinic 75 miles away for those who need it. Planned Parenthood will also refer patients to the Pittsburg, Kansas, clinic about 30 miles away that opened earlier this year.

Muniz said the decision on which clinics to close was data-driven. Many Planned Parenthood patients travel to more than one health center, he said, often picking the one with the soonest availability rather than closest locations.

Two of the remaining St. Louis area clinics — the West County location in Manchester and the St. Peters location — will expand services beginning Nov. 1 to include a Title X family planning program for those who are uninsured or underinsured. 

The clinics in St. Peters will begin seeing patients five days a week, including one Saturday a month, and the Central West End clinic, near downtown St. Louis, will increase appointment availability for health needs including STI testing and treatment, cancer screenings and wellness exams. 

Muniz said the changes are meant to “ensure long-term sustainability in the face of repeated attacks from politicians on sexual and reproductive health care — including seven consecutive years of trying to deny reimbursement for the lifesaving services we provide to Missourians who use Medicaid.”

Lawmakers this year passed a bill, which was signed into law by Gov. Mike Parson, ending Medicaid reimbursements to Planned Parenthood. This means clinics won’t be compensated for patients they serve who are on Medicaid. 

Fights over the legislation earlier this year emphasized Missouri’s reproductive health care and contraceptive deserts. 

Planned Parenthood Great Rivers, like Planned Parenthood Great Plains on the western side of the state, has continued seeing patients on Medicaid despite the new law thanks to donor support, Muniz said. A lawsuit filed by Planned Parenthood claiming the new law is unconstitutional is ongoing.

The decision to consolidate had nothing to do directly with the new legislation, Muniz said. Planned Parenthood Great Rivers serves about 9,000 patients a year on Medicaid. 

The main catalysts, he said, were changes to the health care system because of COVID, and increased requests from patients to access care from home via telehealth options. 

“Our mission is to center the needs of our patients at the core of all of our decision-making,” he said. “Which is why we are making necessary service changes to adapt to their needs.” 

Asked if the consolidation was a cost-saving measure, Muniz said the focus was long-term stability for patients.

Missouri’s reproductive rights amendment, which will appear on the ballot as Amendment 3 , was not a consideration in the decision, Muniz said. He declined to say which Missouri Planned Parenthood locations may initially start providing abortion services again if Amendment 3 passes. 

“We expect amendment 3 to pass, and when it does pass, what abortion access will look like in the state of Missouri is going to be dependent on litigation and what restrictions courts will block from remaining in effect,” he said. 

Christian King, a doula with Uzazi Village in Kansas City, wraps Mikia Marshall, 33, with a kanga cloth to help take pressure off her stomach on Feb. 27, 2024 (Anna Spoerre/Missouri Independent).

In an effort to address Missouri’s deplorable maternal mortality rates, the state issued an emergency rule Monday allowing doulas to be reimbursed through Medicaid for the next six months. 

Doulas — who offer support for families during pregnancy, delivery and postpartum, but do not deliver babies — have been lifted up as one solution to improving maternal and infant health outcomes, especially among low-income families.

Missouri ranked among the bottom half of states for maternal deaths between 2018 and 2022, according to the Centers for Disease Control and Prevention.

“There are evident disparities in the risk of maternal mortality by ethnicity and race, maternal age, access to care, and socio-economic status. Utilizing doula services may reduce maternal mortality, health disparities and improve maternity care for women in Missouri,” the rule states. 

The state Department of Social Services will begin reimbursing doula services to low-income women through MO HealthNet, the state’s Medicaid program, on Tuesday. The program will last through March 28 in the hopes of improving birth outcomes. 

News of the rule change was first reported by the St. Louis Post-Dispatch.

The emergency rule is only six months, but a longer term plan is in the works. On Sept. 27, the Department of Social Services provided public notice of intent to submit a permanent plan.

The program reimburses six total prenatal and postpartum doula visits, attendance at a birth, lactation education services and help navigating community services. Doulas often visit new mothers at their homes during the postpartum period, watching for signs of depression, addiction and violence, all of which have been found to be leading causes of death for women in the year after giving birth.

“There is potential for an offsetting savings in year two and beyond based on the potential reduction in the Cesarean rate as well as other improved birth outcomes,” the rule said.

To be eligible, doulas must be credentialed and certified through a national or Missouri-based doula training organization. From there, they will be added to a list of eligible doulas overseen by the Missouri Community Doula Council.

“I’m pleased to see that ruling,” Hakima Payne, co-founder and CEO of Uzazi Village, said Monday. “It’s a step in the right direction for improving maternal and infant health in Missouri and I’m glad to see the state taking that step.” 

Payne, whose Kansas City nonprofit works to improve birth outcomes, including through doula training programs, said she hopes to see the reimbursement made permanent.

Missouri has long been among the states with the worst maternal health outcomes in the country. 

In Missouri between 2017 and 2021, women on Medicaid were seven times more likely to die within a year of pregnancy than women on private insurance, according to a report published Aug. 30 by the state’s Pregnancy-Associated Mortality Review. 

In those five years, 349 Missouri women died while pregnant or within a year of pregnancy. Black mothers in that time frame were 2.5 times more likely to die within a year of pregnancy than white mothers. 

Of the 70 or so pregnancy-associated deaths each year in Missouri, 77% were deemed preventable. Cardiovascular disease and mental health conditions were among the main causes of pregnancy-related deaths.

“DSS finds an immediate danger to the public health, safety or welfare of pregnant women in Missouri, which requires this emergency action,” Monday’s emergency rule stated. 

A 2023 March of Dimes report gave Missouri a D- for preterm births, and also pointed to doulas as a solution.

The report recommends that health care facilities work with social workers, community health workers and doulas during patients’ pregnancy and post-partum periods, in part to address social determinants of health. 

Missouri doulas give up wages to serve women on Medicaid. Legislators hope to fix that

Okunsola Amadou said formal conversations between doulas and the state around Medicaid reimbursements go back years.

Amadou is founder and CEO of Jamaa Birth Village in Ferguson, the oldest community-based doula organization in the St. Louis region.

In spring 2022, Amadou and Payne were among several people who co-authored a policy brief that highlighted the benefits of doulas on health outcomes and urging “innovation” to bring doulas to more women, particularly those with high-risk pregnancies.

“This policy brief was the trusted, evidence-based document that informed the entire state of Missouri on the importance of doulas,” Amadou said.

When the emergency rule was announced, Amadou said she finally breathed a sigh of relief.

She noted that while the emergency rule, which holds until a permanent plan is finalized, would not financially cover every woman who could benefit from a doula, organizations like Jamaa Birth Village and Uzazi Village will continue to offer scholarships programs for doula services as well.

“We will always back up our community where the state is still trying its best to answer the call,” she said. “ … We have to start somewhere, and I just want to applaud the state for starting somewhere.”

Christian King, a doula in Kansas City who in March told The Independent she had reduced or given up wages to provide services to women on Medicaid who couldn’t afford the assistance, said Monday the state just created a huge opportunity. 

“I hope that with government funding, our hospitals and health training institutions begin to welcome doulas,” King said. “But also respect us and allow us to support birthing persons and their families without a power struggle.”

The order came months after identical bills that would’ve allowed doulas registered with the state to be reimbursed through insurance died before the end of session. The legislation was filed by state Reps. Wendy Hausman, a Republican from St. Peters, and Jamie Johnson, a Democrat from Kansas City. 

Improving the state’s birth outcomes has been heralded as a bi-partisan issue.

In 2023, the Missouri legislature extended postpartum Medicaid coverage from 60 days to one year. Several months after he signed the bill, Gov. Mike Parson called on the state to do more to improve birth outcomes, which he called “embarrassing and absolutely unacceptable.”

This story was updated at 11 a.m. to clarify the financial cost and timeline of the emergency rule, and to add comments from Okunsola Amadou, with Jamaa Birth Village in Ferguson.

Attendees cheer during a Missourians for Constitutional Freedom rally after the campaign turned in more than 380,000 signatures for its initiative petition to enshrine abortion rights in Missouri’s constitution Friday morning (Annelise Hanshaw/Missouri Independent).

Four lawsuits. Several failed attempts to raise the threshold to pass constitutional amendments. One unprecedented attempt to decertify a ballot measure. 

Despite this succession of failed GOP efforts to torpedo Amendment 3 over the past 18 months, abortion will remain on Missouri’s Nov. 5 ballot. 

“What a long strange trip it’s been,” said Michael Wolff, a former Missouri Supreme Court chief justice and dean emeritus at St. Louis University School of Law, quoting Grateful Dead guitarist Jerry Garcia. 

In the 18 months since the amendment, which would legalize abortion up until the point of fetal viability, was proposed as an initiative petition, it has faced a “minefield of ballot litigation” that ended earlier this month when the state’s highest court ruled the measure must stay on the ballot, Wolff said.

On June 24, 2022, Missouri became the first state in the country to ban abortions in response to the U.S. Supreme Court striking down Roe v. Wade and the constitutional right to an abortion. The ruling triggered a state law banning all abortions with limited exceptions in cases of medical emergencies. There are no exceptions for victims or rape or incest. 

Since then, citizens in six states have voted to protect or increase abortion access, including in Kansas, Ohio and Michigan. Missouri is among 10 states where abortion will be on the ballot this year. 

Amendment 3 would legalize abortion until the point of fetal viability and protect other reproductive rights, including birth control.

For anti-abortion lawmakers, “this is like the mega Super Bowl,” said James Harris, a longtime Republican political consultant.

He said litigation to drive up costs for proponents is advantageous, so lawsuits are par for the course. But the secretary of state’s effort to decertify the measure before the court cases concluded was unique.

While all the attempts were ultimately rebuffed by Missouri’s higher courts, they could foreshadow fights to come if Amendment 3 passes.

Sean Nicholson, a long-time progressive activist who has worked on multiple initiative petition campaigns, but is not involved with Amendment 3, called a circuit court ruling earlier this month that threatened to throw the measure off the ballot “some creative lawyering.”

“Nothing shocks me anymore in terms of what politicians are willing to do,” Nicholson said. “I think fundamentally they are terrified of a straight up or down vote on Amendment 3 and they’re going to pull out everything they can to avoid the consequences of voters having their say.”

State Sen. Mary Elizabeth Coleman, a Republican from Arnold, is among the anti-abortion activists who sued to keep Amendment 3 off the ballot. She said regardless of what happens in November, there’s a long road ahead.

“This is not the end all be all,” Coleman said. “And I think you will see efforts, win or lose, for Missourians to get another say in this.” 

In the courts

In March 2023, 11 iterations of what’s now Amendment 3 were filed by Dr. Anna Fitz-James on behalf of the coalition behind the campaign. The political maneuvering by the state’s Republican elected officials aimed at keeping the abortion-rights amendment off the ballot began almost immediately.

Missouri Attorney General Andrew Bailey refused to accept State Auditor Scott Fitzpatrick’s fiscal note summary estimating the potential public cost of the amendment. Bailey, who thought the estimate  should be about $6.9 trillion, attempted to force Fitzpatrick to alter his estimate of $51,000.

By the time Cole County Circuit Judge Jon Beetem ordered Bailey to certify the measure with Fitzpatrick’s estimate, the initial certification process, which is supposed to take no more than 54 days, had already taken nearly double that. The Supreme Court ultimately ruled in favor of Fitzpatrick.

Shortly after, Amendment 3 backers sued Secretary of State Jay Ashcroft over the ballot summary language he drafted, which would have asked Missourians, in part, if they wanted to “allow for dangerous, unregulated, and unrestricted abortions, from conception to live birth.” 

Beetem ruled in September 2023 that Ashcroft’s language was “problematic” and inaccurate. 

Missourians for Constitutional Freedom, the campaign behind the amendment, officially kicked-off signature gathering efforts in January, blaming the previous months of litigation for the delay. 

Despite a May deadline to gather more than 171,000 signatures from Missourians across six of the eight congressional districts, the campaign ultimately filed more than 380,000 signatures with the secretary of state’s office. 

This was despite a “decline to sign” campaign, the distribution of fliers urging Missourians to withdraw their signatures and unsubstantiated warnings that signing the initiative could result in identity theft. 

At the same time, GOP lawmakers failed to pass one of their top priorities — legislation raising the threshold to pass initiative petitions — due in part to a record-breaking filibuster by Senate Democrats.

Chris Melody Fields Figueredo, executive director at the Ballot Initiative Strategy Center, said Missouri has been a battleground for attacks on the initiative process. 

“We’ve seen an escalation of attacks to the ballot measure process and politicians trying to change the rules of the game to prevent citizens from putting these issues on the ballot,” she said. “Like reproductive freedom.”

Shortly after Ashcroft certified the measure for the ballot in mid-August, he posted “fair ballot language” to his official website that mirrored the ballot language rejected by the courts in 2023. Cole County Circuit Judge Cotton Walker ruled the description was “unfair, inaccurate, insufficient and misleading.” 

Ashcroft was ordered to replace his language with the court’s language. 

The final effort to keep Amendment 3 off the ballot began in late August, when a lawsuit filed by anti-abortion lawmakers and activists claimed the initiative petition failed to follow a number of laws. 

Cole County Circuit Judge Christopher Limbaugh sided with the plaintiffs, ruling the proposal failed “to include any statute or provision that will be repealed, especially when many of these statutes are apparent.”

“I do think the circuit court decision is an important inflection point for the legislature to have a policy discussion in [2025] about when all of these measures are putting umpteen things into the constitution which then directly or indirectly invalidate a statute,” James said. “Should the voter clearly know that, and has it been kind of loosy-goosy?”

The Supreme Court took an expedited appeal of Limbaugh’s ruling. But Ashcroft announced he was decertifying the measure, an unprecedented attempt to rescind his previous decision that the measure had met the requirements to be on the ballot.

The next day, the Supreme Court judges said Ashcroft missed his statutory deadline to change his mind and they allowed the measure to stay on the ballot in a narrow 4-3 vote.

“The litigation, although highly charged, tends to wring out the politics of it and get down to what is legally required and how to apply that,” Wolff said, later adding: “It’s still not going to be easy to pass a constitutional amendment in the future, but I think we have some greater clarity about the process going forward.”

Alice Clapman, senior counsel for voting rights at the Brennan Center for Justice — a nonpartisan nonprofit that focuses on democracy issues — said Ashcroft “acted outside the law” when he decertified the ballot initiative.

It was an example of a series of “particularly brazen” attempts to stop abortion ballot initiatives that reflect a much broader pattern seen across the United States, she said. 

“In a way these tactics to block abortion rights ballot initiatives are really doubling down on the repressive nature of abortion restrictions,” Clapman said. 

Ashcroft called Clapman’s characterization of him “patently false,” saying his decision was within reason until the Supreme Court decided otherwise.

“The court did not follow state statute to stop it from going to the ballot,” he said. “I stepped in and did what the court illegally failed to do.”

Ashcroft added that he was “disheartened” by the rulings, but he expects if Amendment 3 passes, “some people will celebrate, and some people will act in the very same way they did in 1973 when Roe v Wade passed. They will work and act to make sure that women and children are protected.”

Missouri isn’t the only state to have a fight over an abortion amendment play out in new ways. 

In Florida, state police have knocked on voters’ doors to question them about signing a petition to restore abortion rights in their state. A state health care agency also created a website denouncing the amendment, and Florida Gov. Ron DeSantis has been particularly vocal in his opposition to it.

In Arkansas, the state Supreme Court upheld the secretary of state’s decision to keep an abortion amendment off the ballot, ruling that the campaign behind the initiative did not submit the correct paperwork on time.

If voters approve Amendment 3, Missouri could be the first state to overturn a statewide ban by the vote of the people. 

2 years after Missouri banned abortion, navigating access still involves fear, confusion

GOP lawmakers over the last decade passed laws targeting abortion providers in order to make obtaining an abortion more difficult. Those laws included mandatory pelvic exams for medication abortions and 72-hour waiting period between the initial appointment and an abortion.

A decade ago, more than 5,000 abortions were performed in the state, according to data from the Missouri Department of Health and Senior Services. But by 2020, that number dropped to 167 as providers closed. Between the Supreme Court decision in June 2022 through March 2024, there were 64 abortions under the state’s emergency exemption, according to data from the Missouri Department of Health and Senior Services. 

Meanwhile, a recent study by the Guttmacher Institute, a reproductive rights research group, found that in 2023, 8,710 Missourians traveled to Illinois and 2,860 Missourians went to Kansas for the procedure, which remains legal in both states. 

What’s next

Polling has remained favorable for Amendment 3. 

An Emerson College poll found 58% of those surveyed support Amendment 3, with 30% opposed. The most recent SLU/YouGov Poll found that 52% supported the amendment and 34% opposed.

State Sen. Tracy McCreery, a Democrat from Olivette and a long-time advocate for abortion rights, said it’s important to keep in mind Missouri’s recent past.

“The legislature has a history of overturning the vote of the people,” she said.

As far back as 1940, when Missourians approved an initiative for a nonpartisan court plan to select appellate judges, the legislature put a proposition on the ballot two years later hoping to repeal it. Voters rejected the attempt. 

In 2010, voters approved a new statute banning puppy mills by regulating dog breeders. The next year, legislation changed key provisions, such as removing the cap on the number of dogs allowed per breeder, undoing the citizen-led statutory change.

In 2018, Missourians passed a citizen-led amendment that would have required legislative districts be drawn to ensure partisan fairness. This amendment, known as “Clean Missouri,” was repealed two years later through a legislature-proposed amendment.

In 2020, Missouri voters approved Medicaid expansion. Lawmakers refused to fund it until the Missouri Supreme Court ruled they had no choice. 

If Amendment 3 passes, McCreery predicted, Republican lawmakers will try something similar to what happened with Medicaid expansion, “but on steroids.”

“I expect shenanigans moving forward,” she said.

Wolff said lawmakers may also attempt to legislate around the issue. Even though parental consent is not directly mentioned in the amendment, lawmakers could try to rewrite laws requiring it. 

Wolff added that he’s never seen such a unified effort by elected officials to stop a ballot measure. Even the heavily-opposed embryonic stem cell research amendment of 2006 didn’t face such pushback.

But lawmakers limited the kinds of research that could be conducted under the stem cell amendment. Ultimately, those restrictions made it impossible for researchers to move forward. 

“(Amendment 3) is going to be harder to chip around about,” Wolff said. “But they’ll be creative. They’ve already been quite creative, so they will continue. That’s what a democratic republic will give you.”

Coleman said if the amendment passes, it will not be the last time Missourians vote on abortion, adding that an effort similar to the one that undid Clean Missouri is likely. 

“The reason why you’ve seen such passion in the pro-life movement or from elected officials who are pro-life is because that reflects the passion of Missouri citizens who are pro-life,” Coleman said. “Which is to do anything and everything to protect the most vulnerable.”

Wolff agreed that this won’t be the end. 

“There’s nothing permanent,” Wolff said, “in the people’s constitution.”

The Missouri Supreme Court takes the bench on Sept. 10, 2024, in Jefferson City to hear a case questioning whether an amendment to overturn the state's abortion ban will remain on the state's November ballot. From left are Judges Kelly C. Broniec, Robin Ransom, W. Brent Powell, Chief Justice Mary R. Russell, Zel. M. Fischer, Paul C. Wilson and Ginger K. Gooch (Pool photo by Robert Cohen/St. Louis Post-Dispatch).

The decision to keep a constitutional amendment legalizing abortion on the November statewide ballot was decided by a narrowly-divided Missouri Supreme Court, according to opinions released Friday.

The majority opinion was written by Judge Paul Wilson, with Chief Justice Mary Russell, Judge Robin Ransom and Judge Brent Powell concurring. 

The dissent was authored by Judge Kelly Broniec, with Judge Zel Fisher and Judge Ginger Gooch concurring in the dissent.

Amendment 3, if approved by a simple majority, would legalize abortion up until the point of fetal viability and protect other reproductive rights, including birth control. Abortion is illegal in Missouri with limited exceptions for medical emergencies. There are no exceptions for victims or rape or incest. 

The Supreme Court, while divided, made one point clear in both the majority and dissenting opinions: “this case is not about abortion.”

“It concerns only what information the constitution requires proponents to include on any initiative petition,” Wilson wrote in the majority opinion. “It is about form and procedure, not substance.”

Wilson was appointed to the court by then-Democratic Gov. Jay Nixon. Russell was appointed by former Democratic Gov. Robert Holden. Powell was appointed by former Republican Gov. Eric Greitens, and Ransom was appointed by current Republican Gov. Mike Parson

Broniec and Gooch were appointed by Parson, and Fisher was appointed by Republican Gov. Matt Blunt.  

Both Gooch and Broniec are up for retention elections this year.

The initial case stemmed from a lawsuit filed in late August by a group of anti-abortion lawmakers and activists claiming the initiative petition that was later certified and approved as an amendment, failed to follow a number of laws. 

This includes a section of state law requiring initiative petitions “include all sections of existing law or of the constitution which would be repealed by the measure.”

The plaintiffs — state Sen. Mary Elizabeth Coleman, state Rep. Hannah Kelly, anti-abortion activist Kathy Forck and shelter operator Marguerite Forrest — sued Secretary of State Jay Ashcroft arguing the initiative petition failed to state any laws that would be repealed if it passed. 

Attorneys for Missourians for Constitutional Freedom, the campaign behind the ballot measure, have said the amendment would not repeal the state’s current abortion law or take it off the books. Instead, they told the courts, it would create a new law that would supersede much of the existing one because not every element of the current law would be rendered moot, including laws protecting women who get abortions from prosecution. 

They also argued anything that falls under the scope of the amendment would be left to the judicial system to interpret and not truly repealed just in the amendment’s passing.

More than 800 Missouri medical professionals sign letter in support of abortion amendment

A majority of the Supreme Court ruled that interpreting the law to require listing every possible provision that could be impacted by an amendment would have “absurd effects.” 

“It seems reasonable to expect that few – if any – initiative petitions could survive under such a statute,” Wilson wrote.

He added that to interpret the statute as such would be unconstitutional because it would impede citizens’ right to the initiative petition process. 

“In fact,” Wilson wrote, “it is hard to imagine how a statute could impair and impede the initiative process more.”

Broniec, in her dissent, took a broader interpretation of the word “repeal,” saying that it is also defined as the ability to “effectively render invalid.”

She called the majority opinion “an absurd result contrary to the plain language” of the state constitution.

If Amendment 3 passes, Broniec wrote, Missouri’s current abortion ban cannot continue to stand. She noted a handful of other current laws that could be in conflict with the amendment, including parental consent for minors and the mandatory 72-hour waiting period between meeting with a doctor and receiving an abortion. 

“Today’s opinion from the Missouri Supreme Court was a complete rejection of the anti-abortion politicians’ arguments and attempts to subvert our constitutional right to vote to protect reproductive freedom,” Tori Schafer, an attorney with the ACLU of Missouri, said in a statement Friday. “Including access to abortion, birth control and miscarriage care.”

Coleman, one of the plaintiffs, wrote on social media Friday that she agreed the issue at hand wasn’t abortion.

“It is about abrogating the will of the general assembly,” Coleman wrote. “By using absurd arguments to reach their desired result.”

Mary Catherine Martin, an attorney with the Thomas More Society who represented the plaintiffs, said in a statement Friday that she still believes the crafters of the initiative petition violated state laws.

“It should not require courage to clearly apply the law, but it does when powerful political forces oppose a just outcome,” Martin said. “We applaud the courage of these three dissenting judges.”

The Supreme Court published its decision on Aug. 10, a few hours after oral arguments were completed and less than three hours before the constitutional deadline to remove a question from the ballot. 

In their decision, the majority reversed a lower court ruling made just four days earlier by Cole County Circuit Judge Christopher Limbaugh, who recommended the measure be stripped from the Nov. 5 ballot. 

As part of its decision, the Supreme Court ordered that Ashcroft “certify to local election authorities that Amendment 3 be placed on the Nov. 5, 2024, general election ballot and shall take all steps necessary to ensure that it is on said ballot.” 

A day earlier, Ashcroft, in an unprecedented move, attempted to decertify the ballot measure based on the lower court’s ruling, and temporarily removed Amendment 3 from the Secretary of State’s website.

Correction: This story was updated at 4:10 p.m. to clarify that Chief Justice Mary Russell was appointed by former Democratic Gov. Bob Holden.

Dr. Jennifer Smith, an OB-GYN in St. Louis, was among 800 Missouri medical professionals who signed a letter in support of Amendment 3, which would legalize abortion up to the point of fetal viability (Annelise Hanshaw/Missouri Independent).

Dr. Betsy Wickstrom says she’s still lacking clarity on what constitutes a medical emergency under Missouri’s abortion ban, despite the law having been in place for more than two years. 

In Missouri, health care providers who perform abortions not deemed necessary emergencies can be charged with a class B felony, which means up to 15 years in prison. Their medical license can also be suspended or revoked.

So Wickstrom, a high-risk obstetrician in Kansas City more than three decades into her career, must first consult a team of lawyers.

“When we have something that looks like it’s skirting the line and there’s a flicker of a heartbeat, but someone is desperately ill, sure I can call up the attorney,” she told reporters Monday. “But they’re not going to put the hospital’s licensure on the line. They’re going to say ‘you know, good thing you live next to Kansas.’”

Dr. Jennifer Smith, an OB-GYN in St. Louis, agreed. 

“I don’t think that many hospitals feel comfortable testing this law because the government hasn’t provided us any clarity on it,” Smith said. 

Wickstrom and Smith are among more than 500 physicians and more than 300 other medical professionals who signed a letter in support of Amendment 3. If approved by a majority of Missourians on Nov. 5, the amendment would overturn Missouri’s near-total abortion ban and legalize the procedure up until the point of fetal viability. 

Missouri became the first state to enact a trigger law banning abortion except for cases of medical emergencies following the fall of Roe v. Wade in June 2022. There are no exceptions for survivors of rape or incest.

“As a result, Missourians are being denied abortions and forced to continue life-threatening pregnancies, risking their health and lives,” the medical professionals wrote in a letter through the Committee to Protect Health Care. “Doctors can’t treat patients with heartbreaking pregnancy complications until they are on the brink of death. Otherwise, they could be put in jail.”

The situation in Missouri leaves pregnant patients with few options, the group of physicians contend.

“It forces many to leave the state to receive care,” the letter continues, “while others are forced to carry a pregnancy against their will. No one should ever have their health deteriorate or need to flee to receive care, nor should anyone have to carry a pregnancy against their will.”

Between June 2022 and March 2024, 64 abortions were performed in Missouri under the state’s emergency exemption, according to data from the Missouri Department of Health and Senior Services.

Missouri among worst states for women’s overall health, reproductive care, study finds

Wickstrom said she often has difficult conversations with women about growing their families — conversations made more difficult by the ban. 

She has patients diagnosed with cancer who were advised not to start chemotherapy while pregnant. And she has patients with heart disease who might not survive another pregnancy. 

“But can I do anything about that in Missouri?” Wickstrom said. “No. These are people that have to find their way out of the state to get life-saving care.” 

Smith, who has been an OB-GYN in eastern Missouri for more than 20 years, said the questions she’s hearing from patients now are unlike any she’s heard in the past. 

“People are very hesitant to start their families and expand their families in this environment,” she said. 

In the past two years Smith said she’s had men ask her to promise to save their partner before their baby if something were to go wrong during a wanted pregnancy. 

Patients planning their families face similar fears.

“Do you think that it’s safe to be pregnant here? What if I have an ectopic? What if I have a miscarriage?” Smith said she hears often from patients. “What if something’s wrong with the pregnancy? What if something’s wrong with me?”

Supporters of Amendment 3 celebrate on Tuesday, Sept. 10, 2024, on the steps of the Missouri Capitol after the state Supreme Court ruled the abortion-rights measure could remain on the ballot (Anna Spoerre/Missouri Independent).

Missouri’s campaign to legalize abortion has more than doubled its fundraising totals since it was approved for the ballot in mid-August, despite — and perhaps fueled by — a lawsuit that threatened to knock it off the Nov. 5 ballot. 

Missourians for Constitutional Freedom, the coalition behind what will appear on the ballot as Amendment 3, has raised more than $16 million since launching in January, according to reports filed with the Missouri Ethics Commission.

Of that, $9 million in donations greater than $5,000 were reported to the commission since the measure was certified for the ballot on Aug. 13. Campaigns are required to report any donations over $5,000 within 48 hours of receiving them. Reports totaling all donations and expenditures are due to the state each quarter. 

The two most well-established political action committees working to fight the amendment include Missouri Stands with Women, which has raised at least $200,000, and Missouri Right to Life, which has raised nearly $675,000 this election cycle.

The largest donations to Missourians for Constitutional Freedom have come from four out-of-state progressive nonprofits that are not required to disclose their donors and are also helping fund reproductive-rights campaigns in several states. 

As of Thursday, the Sixteen Thirty Fund based out of Washington D.C. donated $4.5 million to Missouri’s effort. That includes a $3.5 million check on Aug. 30 — the second largest single donation in Missouri this year. 

The Fairness Project, also based out of Washington D.C., has donated $2.9 million. Most of that money came on Aug. 23, when the organization cut a $2.1 million check to the campaign. 

Both nonprofits also contributed significant funds to the state’s 2020 Medicaid expansion initiative petition effort, which ultimately succeeded, and to the current ballot effort to raise the minimum wage and mandate paid sick leave.

The campaign also received $1 million from a nonprofit out of Washington D.C. listed as Open Source Action Fund, which is linked to an address for Open Society Action Fund. The nonprofit was founded by George Soros, a liberal billionaire.

On Thursday, a Virginia-based nonprofit called Global Impact Social Welfare donated $750,000.

Successful statewide ballot initiative campaigns are often multi-million dollar endeavors. 

Missouri Supreme Court rules amendment legalizing abortion will remain on ballot

“It is expensive, and in these places where we can do it, it is the least expensive pathway to restoring rights,” Kelly Hall, executive director of The Fairness Project, said at a panel discussion during the Democratic National Convention. “In Missouri, for example, it would take a lot more money to flip that legislature and to flip that gubernatorial seat … the best (return on investment) we can get is putting this on the ballot and appealing to those Missouri voters who do want this.”

In an interview with The Independent, Hall said The Fairness Project is both a leading funder and a coalition partner of Missourians for Constitutional Freedom. The coalition also includes the state’s Planned Parenthood affiliates, the ACLU of Missouri and Abortion Action Missouri. 

She said any assumption that they simply parachute money into states is false. 

“It is impossible for nonprofits like us who may have resources to bring to bear to achieve anything without a campaign that is grounded in grassroots support and the support of Missouri voters,” Hall said. 

The fact that the nonprofits helping bankroll the campaign don’t disclose their donors has become a point of attack from anti-abortion activists and lawmakers in Missouri. 

“There is going to be a massive effort — and by massive I mean to the tune of millions of dollars,” U.S. Sen. Josh Hawley said of the abortion ballot campaign at a conference last weekend in Missouri. “Already, George Soros and dark money groups have poured into this state almost $5 million to begin spending on this radical amendment.” 

Stephanie Bell, a spokeswoman for Missouri Stands with Women, blamed “out-of-state liberal groups” for boosting the abortion-rights campaign’s finances.

On Tuesday, after the Missouri Supreme Court reversed a lower court’s attempt to take Amendment 3 from the ballot, Lt. Gov. Mike Kehoe, the front-runner for governor, called the ballot measure “a deceptive effort by out-of-state interests.” The Missouri Republican Party called Amendment 3 “bankrolled by radical out-of-state interest groups.” 

Hall, with The Fairness Project, said she doesn’t usually push back on “dark money” criticisms. 

“If they want to focus on this rather than on the issue that Missouri voters care about, which is making sure that everyone in their state has access to lifesaving reproductive health care when they need it,” she said, “then that’s a misread on their part of what Missouri voters care most about.” 

The campaign has seen overwhelming support from across the state, collecting initiative petition signatures from every county and turning in more than 380,000 signatures to the Missouri Secretary of State’s Office in May.

While the top donors have come from out of state, the campaign has also raised several million dollars so far from Missouri individuals and organizations.

Planned Parenthood Great Plains and Planned Parenthood Great Rivers, which have clinics in Missouri, have donated more than $1.1 million. The ACLU of Missouri has donated more than $620,000, the Health Forward Foundation based in Kansas City donated $500,000 and Abortion Action Missouri has given more than $230,000.

The campaign stresses that the largest donor base remains Missourians affected by the ban. 

“Throughout the campaign, eight out of 10 online contributions have come from right here in Missouri,” Rachel Sweet, campaign manager for Missourians for Constitutional Freedom, said in a statement. “Underscoring the true grassroots nature of this movement.”

Sweet said that in the days following a Friday ruling by a Cole County circuit judge that threatened to remove Amendment 3 from the ballot, more than 2,400 Missourians donated a quarter million dollars to the campaign. 

If Amendment 3 passes by a simple majority in November, Missouri could become the first state to overturn an abortion ban by the vote of the people. It would also join several other states that successfully protected abortion-rights through citizen-led ballot campaigns since Roe v. Wade was overturned in June 2022. 

Abortion is illegal in Missouri, with limited exceptions for medical emergencies. The amendment would legalize abortion up until the point of fetal viability and protect access to other reproductive health care, like birth control. 

“It is truly the grassroots infrastructure in Missouri,” Kelly said. “And the leadership of in-state partners in every ballot measure campaign that advances to voters that we’ve been involved in that make it such an inspiring place to work.”

This story was updated at 12:22 p.m. to correctly state that The Fairness Project is based out of Washington D.C.

The Missouri Supreme Court takes the bench on Sept. 10, 2024, in Jefferson City to hear a case questioning whether an amendment to overturn the state's abortion ban will remain on the state's November ballot. From left are Judges Kelly C. Broniec, Robin Ransom, W. Brent Powell, Chief Justice Mary R. Russell, Zel. M. Fischer, Paul C. Wilson and Ginger K. Gooch (Pool photo by Robert Cohen/St. Louis Post-Dispatch).

Missourians will have the opportunity to vote to enshrine abortion in the state constitution this November, the Missouri Supreme Court ruled Tuesday.

In a decision published less than three hours before the constitutional deadline to remove a question from the ballot, the Supreme Court reversed a lower court’s ruling that recommended the measure be stripped from the Nov. 5 ballot.

Secretary of State Jay Ashcroft “shall certify to local election authorities that Amendment 3 be placed on the Nov. 5, 2024, general election ballot and shall take all steps necessary to ensure that it is on said ballot,” the judgment read.

The court has not yet issued an opinion.

“This fight was not just about this amendment—it was about defending the integrity of the initiative petition process and ensuring that Missourians can shape their future directly,” Rachel Sweet, campaign manager for Missourians for Constitutional Freedom, the campaign behind the amendment, said in a statement.

In a lawsuit filed late last month, a number of anti-abortion lawmakers and activists sued Missouri Secretary of State Jay Ashcroft for certifying Amendment 3 for the ballot.

The suit was brought forward by state Sen. Mary Elizabeth Coleman, state Rep. Hannah Kelly, anti-abortion activist Kathy Forck and shelter operator Marguerite Forrest who in a statement Tuesday said the Supreme Court “turned a blind eye” in its ruling.

“The fight continues against the vile forces who have no regard for innocent life,” they wrote.

On the eve of the Supreme Court hearing, Ashcroft announced he was decertifying the measure, a potentially unprecedented attempt to rescind his previous decision in an attempt to block the measure from the ballot.

The Supreme Court judges said Ashcroft missed his statutory deadline to change his mind.

“Respondent Ashcroft certified the petition as sufficient prior to that deadline, and any action taken to change that decision weeks after the statutory deadline expired is a nullity and of no effect,” the judges wrote.

Amendment 3 — which had been stripped from the Secretary of State’s website on Monday — was again listed under 2024 ballot measures as of 3:30 p.m. Tuesday.

Judge calls Ashcroft’s characterization of abortion amendment ‘unfair’ and ‘misleading’

In order to get a citizen-led Amendment on the ballot, the campaign behind the measure must first collect enough signatures from six of Missouri’s eight congressional districts. When asked for signatures, state law requires that the amendment be attached in full.

The initiative petition circulated by Missourians for Constitutional Freedom did not include any current law that would be repealed, the issue at the crux of the lower court’s ruling.

There is also a section of state law that requires initiative petitions “include all sections of existing law or of the constitution which would be repealed by the measure.”

Attorneys for Missourians for Constitutional Freedom have said the amendment would not repeal the state’s current abortion law or take it off the books. Instead, they said, it would create a new law that would supersede much of the existing one because not every element of the current law would be rendered moot, including laws protecting women who get abortions from prosecution.

And, they added, anything that falls under the scope of the amendment would be left to the judicial system to interpret.

Cole County Circuit Judge Christopher Limbaugh did not agree. On Friday he ruled that the campaign did not meet the sufficiency requirement through a “failure to include any statute or provision that will be repealed, especially when many of these statutes are apparent.”

While Limbaugh recommended the amendment be taken off the ballot, he ultimately left the decision up to a higher court.

Four days later, the Supreme Court ultimately ruled in favor of Missourians for Constitutional Freedom.

“What this decision really says today is that we deserve to be on the ballot,” said Tori Schafer, an attorney with the ACLU of Missouri, which is part of the coalition behind the amendment. ”That people deserve to make this decision for themselves.”

If passed on Nov. 5, the amendment would go into effect 30 days later. At that point, Schafer said there will likely be a series of legal challenges to clarify what the amendment means.

“But it’s very clear that when the amendment goes into effect, our state’s total abortion ban is over,” Schafer said.

The amendment reads in part: “The government shall not deny or infringe upon a person’s fundamental right to reproductive freedom, which is the right to make and carry out decisions about all matters relating to reproductive health care.”

Abortion is illegal in Missouri with limited exceptions for medical emergencies. If the amendment passes by a simple majority, it would legalize abortion up until the point of fetal viability and protect other reproductive rights, including birth control.

Mary Catherine Martin, an attorney with the Thomas More Society who argued the case on behalf of the plaintiffs, called the Supreme Court’s decision a “failure to protect voters.”

“We implore Missourians to research and study the text and effects of Amendment 3 before going to the voting booth,” she said in a statement.

Forck, one of the plaintiffs, was among a handful of anti-abortion activists who remained outside the Supreme Court building once a decision came down.

“We are resolved firmly to let the people of Missouri know exactly how insidious this Amendment 3 is,” she said, later adding: “This is a very slippery slope.”

The Missouri Republican Party called the ruling “devastating.”

“This ruling marks the most dangerous threat to Missouri’s pro-life laws in our state’s history,” the party said in a statement Tuesday. “Make no mistake—this amendment, bankrolled by radical out-of-state interest groups, is a direct assault on Missouri families and the values we hold dear.”

So far, Missourians for Constitutional Freedom has raised more than $15 million for the campaign, including seven-figure donations from national groups whose funders are not listed, including the Fairness Project.

With the general election only eight weeks away, Democratic candidates drew on news of the Supreme Court decision to call on supporters.

“Voters will overturn Missouri’s cruel ban that has zero exceptions for rape and incest,” Crystal Quade, the Democratic nominee for governor, said in a statement. “And they deserve a governor who will protect the will of voters and the rights of every Missourian.”

Lucas Kunce, the Democrat running against incumbent U.S. Sen. Josh Hawley, took an opportunity to call out Hawley’s opposition to Amendment 3.

“The lies and lawfare,” Kunce said, “used by Josh Hawley and his allies to try to block a citizen-led effort to end their total abortion ban have failed.”

This story was updated at 4:50 p.m. to include reaction to the ruling.

Chuck Hatfield, an attorney for Missourians for Constitutional Freedom, argues before the Missouri Supreme Court on Tuesday, Sept. 10, 2024 in Jefferson City as the court hears a case questioning whether an amendment to overturn the state's abortion ban should remain on the November ballot (Pool photo by Robert Cohen/St. Louis Post-Dispatch).

The Missouri Supreme Court heard arguments Tuesday morning over whether to allow an abortion-rights amendment to remain on the Nov. 5 ballot. 

The court will decide whether the campaign behind Amendment 3, which would legalize abortion up until the point of fetal viability and protect other reproductive rights, failed to comply with state law when drafting its initiative petition, the text circulated among registered voters. 

They are expected to rule quickly, since the deadline to remove a question from the ballot is 5 p.m. 

A group of anti-abortion lawmakers and activists filed a lawsuit late last month asking the court to take the measure off the ballot, saying the initiative petition failed to list what specific existing laws would be repealed if the amendment passed. 

Missouri law requires that initiative petitions “include all sections of existing law or of the constitution which would be repealed by the measure.” 

Hours after a bench trial in circuit court on Friday, Cole County Circuit Judge Christopher Limbaugh ruled in favor of the plaintiffs, recommending that the measure be taken off the ballot because the citizen-led ballot measure failed to meet the sufficiency requirement through a “failure to include any statute or provision that will be repealed, especially when many of these statutes are apparent.” But he left the ultimate authority up to a higher court.

In their briefing to the Supreme Court, the attorneys representing the anti-abortion group wrote that no comparable case has been brought before the court in the past. 

“That is because proposed Amendment 3 is novel in its attempt to attach unlimited other subjects to a single, enormous issue that is so controversial that it eclipses all others in the minds of voters, the media and even the secretary of state,” they wrote. 

Chuck Hatfield, an attorney representing Missourians for Constitutional Freedom, the campaign behind the amendment, argued to the Supreme Court Tuesday that the opposition’s briefs were “light on legal arguments but weighty with political argument.”

He chalked the lawsuit — filed by state Sen. Mary Elizabeth Coleman, state Rep. Hannah Kelly, anti-abortion activist Kathy Forck and shelter operator Marguerite Forrest — up to politics. 

“The fact that [abortion] is controversial does not mean that the courts and state officials should cast aside the fundamental right to have that vote,” he said. 

He maintained that because the amendment would not literally repeal any part of the law on its own, the campaign did not err. He added that constitutional amendments never repeal state statutes from the books. Instead, courts can render other statues invalid as a result of further legal action. 

Mary Catherine Martin, an attorney with the Thomas More Society arguing the case Tuesday on behalf of the plaintiffs, reiterated her contention that the initiative petition illegally included more than one subject, pointing to language protecting “a person’s fundamental right to reproductive freedom” and saying such a phrase encompasses “infinite subjects.” 

Attorneys for Missourians for Constitutional Freedom said the single subject is “reproductive freedom.” 

While Limbaugh did not rule on this single subject claim, the Supreme Court has the opportunity to.

After the hearing, both sides agreed on one point: the case is novel. 

Martin called the amendment novel in all that it encompasses.

Tori Schafer, an attorney with the ACLU of Missouri, which is part of the coalition behind the amendment, said the same of the plaintiffs’ procedural arguments.

Schafer said while an amendment hasn’t been ordered off the Missouri ballot in several decades, Limbaugh’s ruling “threatens to grind our system of constitutional initiative petition to a halt at the last minute, leaving in its wake the disenfranchisement of hundreds of thousands of voters …”

Martin said they are not trying to “undermine” voters, but rather “protect” them.

“We’ve worked for 50 years for the right to vote on abortion and I would desperately like, along with all Missouri voters, the opportunity to actually do so,” she said. “And not to have to vote on all of these issues at the same time.”

Amendment 3 would establish the constitutional right to an abortion up until fetal viability and grant constitutional protections to other reproductive health care, including in-vitro fertilization and birth control. It would also protect those who assist in an abortion from prosecution. 

Abortion is illegal in Missouri, with limited exceptions for medical emergencies.

Since the Supreme Court decision in June 2022 through March 2024, there were 64 abortions performed in Missouri under the state’s emergency exemption, according to data from the Missouri Department of Health and Senior Services. 

Meanwhile, thousands of Missourians have crossed state lines for the procedure. Last year, about 2,860 Missourians traveled to Kansas and 8,710 traveled to Illinois for abortions, according to the Guttmacher Institute, a reproductive rights research group that closely tracks abortion data.

Ashcroft decertifies measure ahead of ruling

On the eve of the Supreme Court hearing, Missouri Secretary of State Jay Ashcroft decertified the ballot measure, a potentially unprecedented attempt to rescind his previous decision in an attempt to block the measure from the ballot.

As of Tuesday morning, Amendment 3 remained absent from the secretary of state’s website listing measures to appear on the November ballot.

Ashcroft said he’d mistakenly certified Amendment 3. 

Attorneys representing Ashcroft in Cole County Court on Friday defended his decision. But on Monday, they said he’d realized his error

“This court should simply dismiss this appeal because the appeal has now become moot,” an attorney for Ashcroft told the Supreme Court on Tuesday, adding that Ashcroft believes he has the authority to decertify any measure up until eight weeks before the election.

Judge calls Ashcroft’s characterization of abortion amendment ‘unfair’ and ‘misleading’

Attorneys for the Missourians for Constitutional Freedom in a filing Monday evening asked that Ashcroft be held in contempt of court, adding that his decision went against the court’s stay order filed Monday morning that kept the amendment on the ballot until the highest court’s decision was made.

Hatfield told the judges Tuesday that his team filed a motion asking the court to stay the lower court’s order and keep the amendment on the ballot until they made a decision because “the secretary of state is going to be up to shenanigans and we need a stay” to prevent a “crisis in the system.”  

He recognized the contempt request was “highly unusual” and put the court in a “predicament.”

“It’s open contempt for your authority, It’s open contempt for the rule of law,” Hatfield said of Ashcroft. “It’s open contempt for the proper administration of justice to tell the public that he’s going to take it off the ballot even though we’re here this morning having this discussion.”

Missouri Secretary of State Jay Ashcroft joined the Midwest March for Life on May 1 at the Missouri State Capitol. “I think regardless of what the legislature does, the people of this state – with hard work – can protect all life in this state," Ashcroft said (Anna Spoerre/Missouri Independent).

Missouri Secretary of State Jay Ashcroft decertified a ballot measure that would legalize abortion, a move aimed at blocking it from appearing on the November ballot, according to a brief filed Monday with the state Supreme Court.

Last month, Ashcroft announced the reproductive-rights proposal would appear on the ballot as Amendment 3. But a Cole County judge on Friday ruled the amendment violated state law and shouldn’t have been certified. 

That ruling is now before the Missouri Supreme Court, with a hearing scheduled Tuesday morning and a ruling expected quickly thereafter. The deadline to remove a question from the ballot is also Tuesday. 

But before the Supreme Court had the chance to weigh in, Ashcroft said he had changed his mind. 

“On further review in light of the circuit court’s judgment, the Secretary believes the amendment is deficient,” the secretary of state argues in a filing with the court. 

As of Monday afternoon, Amendment 3 was no longer listed on the secretary of state’s website as appearing on the November ballot.

“The amendment proponents cannot evade constitutional requirements that advocates of other amendments must and have satisfied simply because the proposed amendment concerns a highly charged moral topic,” the brief read. “This court should enforce the circuit court’s judgment.”

Attorneys for the campaign in a filing Monday evening asked that Ashcroft be held in contempt of court, adding that his decision went against the court’s stay order filed Monday morning that kept the amendment on the ballot until the highest court’s decision was made.

“Secretary Ashcroft’s letter directly tends to interrupt this court’s proceeding and impair respect for this court’s authority,” the filing read.

Rachel Sweet, campaign manager for the campaign behind Amendment 3 — Missourians for Constitutional Freedom — said in a statement Monday that the Supreme Court has jurisdiction at this point, not Ashcroft.

Sweet added the campaign is “confident the court will order the secretary of state to keep Amendment 3 on the ballot.”

Cole County Circuit Judge Christopher Limbaugh ruled last week that the measure should be taken off the ballot, but deferred to a higher court for a final ruling. Missourians for Constitutional Freedom quickly appealed.

Missouri law requires that initiative petitions “include all sections of existing law or of the constitution which would be repealed by the measure.” 

During a circuit court hearing Friday, an attorney representing Ashcroft maintained the office believed that the measure met the minimum requirements to be certified. 

Judge calls Ashcroft’s characterization of abortion amendment ‘unfair’ and ‘misleading’

The anti-abortion plaintiffs who challenged the legality of the amendment have argued that because the campaign behind the ballot measure didn’t list the exact statutes that would be repealed on the initiative petition, the measure is invalid. Attorneys representing Missourians for Constitutional Freedom continue to argue that the measure, if passed, would not truly repeal any part of Missouri’s constitution, but rather supersede most of the current ban on the books. 

Missourians for Constitutional Freedom turned in signatures of more than 380,000 Missourians across the state who supported the issue landing on the ballot. If Amendment 3 is ultimately on the Nov. 5 ballot and wins by a simple majority, Missouri could be the first state to overturn an abortion ban.

Amendment 3 would establish the constitutional right to an abortion up until fetal viability and grant constitutional protections to other reproductive health care, including birth control. It would also protect those who assist in an abortion from prosecution. 

Nearly every abortion, with limited exceptions for the life and health of the mother, has remained illegal in Missouri since June 2022, when the U.S. Supreme Court overturned the constitutional right to the procedure. Missouri’s ban does not include exceptions for victims of rape or incest.

The plaintiffs — state Sen. Mary Elizabeth Coleman, state Rep. Hannah Kelly, anti-abortion activist Kathy Forck and shelter operator Marguerite Forrest — said in a statement Friday evening that the amendment’s scope is about more than just abortion and could be interpreted to also include gender-affirming care and human cloning.

This story was updated at 5:55 p.m. to include a filing from attorneys for the Amendment 3 campaign asking that Ashcroft be held in contempt of court.

Supporters of a proposed ballot measure to legalize abortion up until the point of fetal viability gathered at a rally hosted by Missourians for Constitutional Freedom on Feb. 6 in Kansas City (Anna Spoerre/Missouri Independent).

The Missouri Supreme Court will decide whether abortion-rights will end up on the Nov. 5 ballot after a Cole County judge ruled the proposed amendment violated state law. 

The case bypassed the court of appeals over the weekend and headed straight to the state’s highest court, which scheduled oral arguments for 8:30 a.m. Tuesday — the same day ballots are supposed to be printed for those voting absentee. 

Sunday afternoon, attorneys representing the campaign behind the amendment, which would appear on the ballot as Amendment 3, filed an emergency motion asking the court to allow it to proceed to the ballot while the case plays out. Doing so, they argued, would “preserve the status quo and prevent irreparable harm to intervenors-appellants, election officials throughout the state and Missouri voters themselves.”  

Amendment 3 would establish the constitutional right to an abortion up until fetal viability and grant constitutional protections to other reproductive health care, including in-vitro fertilization and birth control. It would also protect those who assist in an abortion from prosecution. 

Abortion is illegal in Missouri, with limited exceptions for the life and health of the mother.

2 years after Missouri banned abortion, navigating access still involves fear, confusion

In late August, a group of anti-abortion lawmakers and activists sued Missouri Secretary of State Jay Ashcroft, accusing him of wrongly certifying the citizen-led ballot initiative for the Nov. 5 ballot nine days earlier. 

Late Friday evening, Cole County Circuit Judge Christopher Limbaugh ruled in favor of the plaintiffs, saying the text of the initiative petition failed to list what existing laws would be repealed if it passed, as he said is required by state law. 

He suggested the amendment be withheld from the ballot, but also left the door open for an appeal to a higher court, saying he recognized  “the gravity of the unique issues involved in this case, and the lack of direct precedent on point.” 

Limbaugh was appointed to the newly-created judicial position in the 19th circuit on Aug. 2 by Missouri Gov. Mike Parson, for whom he previously served as general counsel. 

He was previously a potential candidate to replace Eric Schmitt as Missouri Attorney General after he was elected to the U.S. Senate. His father was a federal court judge and his cousin was the late Rush Limbaugh, a conservative radio host who was awarded the Presidential Medal of Freedom by former President Donald Trump.  

Missourians for Constitutional Freedom, the campaign behind the amendment, quickly appealed his decision.

“Judges come from their own experience and background, and they’re not perfect,” Emily Wales, president and CEO of Planned Parenthood Great Plains Votes, a member of the Missourians for Constitutional Freedom coalition, said Sunday, later adding: “What we’re asking is that the Supreme Court hold us to the same standard everyone else has had.”

Missouri law requires that initiative petitions “include all sections of existing law or of the constitution which would be repealed by the measure.” 

Loretta Haggard, an attorney representing the campaign said during a hearingFriday that the amendment would not literally repeal the state’s current abortion law and take it off the books, but rather would create a new law that would supersede much of the existing one. 

She said this is because not every element of the current law would be rendered moot: the two texts overlap in that both protect women who get abortions from prosecution and both restrict abortion after fetal viability, generally seen as the point at which a fetus can outside the womb, generally around 24 weeks pregnancy. 

Anything else that falls under the scope of the amendment would be left to the judicial system to interpret, Haggard said. 

During the trial, Mary Catherine Martin, an attorney with the Thomas More Society representing the plaintiffs, also argued the initiative petition illegally included more than one subject, pointing to language protecting “a person’s fundamental right to reproductive freedom” and saying such a phrase encompasses “infinite subjects.”

Haggard contended that the single subject was clear: “reproductive freedom.”

While Limbaugh ruled the initiative petition did not meet the sufficiency requirement through a “failure to include any statute or provision that will be repealed, especially when many of these statutes are apparent,” he did not address the single subject claims in his decision. 

The plaintiffs — state Sen. Mary Elizabeth Coleman, state Rep. Hannah Kelly, anti-abortion activist Kathy Forck and shelter operator Marguerite Forrest — said in a statement Friday evening that the amendment’s scope is about more than just abortion and could be interpreted to also include gender-affirming care and human cloning. Neither are mentioned by name in the amendment, nor is in-vitro fertilization.

“There is no way to know if the proponents of this radical amendment would have gathered enough signatures to place this on the ballot if the truth about the staggering scope of laws Amendment 3 invalidates had been disclosed,” they said in a statement. 

Wales said the campaign behind Amendment 3 remains undeterred despite the ruling. 

“We are right on the law. The history of how initiative petitions have worked in this state has meant that they’re able to vote on their rights,” Wales said. “The constitution creates a process for citizens to engage in democracy, not one that’s intended to trip them up or hinder them from participating in democracy. We think the court is going to see that.”  

In May, the campaign turned in signatures from more than 380,000 Missourians across the state who supported the issue landing on the ballot. If Amendment 3 is ultimately voted on in November and wins by a simple majority, Missouri could be the first state to overturn an abortion ban by citizen-vote.

“These ballot initiatives just go through shenanigans, often at the eleventh hour, and what it does again every time is fire people up,” Wales said. “We expect to win, and we’re going to take all the energy and use it to galvanize folks to win in November.”

Mary Catherine Martin, an attorney with the Thomas Moore Society, represented a group of Missouri anti-abortion lawmakers and activists Friday, Sept. 6, 2024, during a trial at the Cole County Courthouse (Anna Spoerre/Missouri Independent).

A Missouri judge ruled Friday evening that a reproductive-rights amendment did not comply with state initiative petition requirements, leaving the door open to potentially withhold it from the November ballot. 

Cole County Circuit Judge Christopher Limbaugh ruled that the coalition behind the citizen-led ballot measure failed to meet the sufficiency requirement through a “failure to include any statute or provision that will be repealed, especially when many of these statutes are apparent.”

A spokesperson for Missourians for Constitutional Freedom, the campaign behind the reproductive-rights amendment, said they plan to appeal. 

Limbaugh also wrote that while he found a “blatant violation” of state law, he “recognizes the gravity of the unique issues involved in this case, and the lack of direct precedent on point.” 

As a result, he won’t issue an injunction preventing the amendment from being printed on the ballot until Tuesday to allow time for “further guidance or rulings” from the appeals court. 

The constitutional deadline for ballots to be printed is Tuesday. 

Amendment 3 would establish the constitutional right to an abortion up until fetal viability and grant constitutional protections to other reproductive health care, including in-vitro fertilization and birth control. It would also protect those who assist in an abortion from prosecution. 

“The court’s decision to block Amendment 3 from appearing on the ballot is a profound injustice to the initiative petition process,” Rachel Sweet, campaign manager with Missourians for Constitutional Freedom, said in a statement. “And undermines the rights of the 380,000 Missourians who signed our petition demanding a voice on this critical issue.

The lawsuit was filed two weeks ago by a group of anti-abortion lawmakers and activists against Missouri Secretary of State Jay Ashcroft, who certified the citizen-led ballot initiative for the Nov. 5 ballot  nine days earlier. The group is arguing that the initiative should never have been allowed on the ballot.

The plaintiffs — state Sen. Mary Elizabeth Coleman, state Rep. Hannah Kelly, anti-abortion activist Kathy Forck and shelter operator Marguerite Forrest — said in a statement Friday evening that the amendment’s scope is “staggering.” 

“Missourians have a constitutional right to know what laws their votes would overturn before deciding to sign initiative petitions,” they said. “Amendment 3 isn’t just about abortion.”

The plaintiffs were represented in court by Mary Catherine Martin, an attorney with the Thomas More Society who argued during a brief bench trial Friday morning that the campaign behind the amendment fell short of the law by failing to list the specific laws or constitutional provisions which would be repealed if the amendment is approved by voters. 

Missouri law requires that initiative petitions “include all sections of existing law or of the constitution which would be repealed by the measure.” 

“No one disputes,” she said, “one of its primary purposes and effects is to repeal Missouri’s ban on abortion.” 

Speculation isn’t necessary to come to this conclusion, Martin said, pointing to the ballot summary which reads, in part, that a yes vote would “remove Missouri’s ban on abortion.”

Loretta Haggard, an attorney representing the campaign supporting the amendment, said that while the amendment would supersede existing law, it would not erase it from the current constitutional text, and therefore would not truly repeal the current statute. 

She told the judge in court that this is because the two texts do have some overlapping similarities: both protect women who get abortions from prosecution and both restrict abortion after the point of fetal viability. 

Fetal viability is an undefined period of time generally seen as the point in which the fetus could survive outside the womb on its own, generally around 24 weeks, according to the American College of Obstetricians and Gynecologists.  

When it comes to everything else, Haggard said, the amendment would leave the current law to be interpreted through the lens of the new law, meaning any restrictions implemented by the government on abortion prior to fetal viability will have to withstand strict scrutiny in court to remain. She ventured that most of Missouir’s current restrictions would not survive for this reason.

Ultimately, Limbaugh sided with the plaintiffs, writing that the page attached to the initiative petition forms “included no disclaimer or any equivalent to a disclaimer.” 

“In fact,” he concluded. “The full and correct text failed to identify any ‘sections of existing law or of the constitution which would be repealed by the measure.’”

Tori Schafer, an attorney with the ACLU of Missouri, speaks to media following a trial over Amendment 3 on Friday, Sept. 6, 2024, outside the Cole County Courthouse (Anna Spoerre/Missouri Independent).

A lawsuit attempting to knock a reproductive-rights amendment off the November ballot could hinge on whether it would immediately repeal Missouri’s current near-total ban on abortion, an issue disputed during a two-hour-long hearing Friday.

Cole County Circuit Judge Christopher Limbaugh said at the completion of Friday’s hearing that he intends to rule quickly because the constitutional deadline for ballots to be printed is Tuesday. 

Two weeks ago, a handful of anti-abortion lawmakers and activists filed a lawsuit against Missouri Secretary of State Jay Ashcroft, who certified the citizen-led ballot initiative for the Nov. 5 ballot  nine days earlier. The group is arguing that the initiative should never have been allowed on the ballot, and they are asking the judge to keep it from being voted on this fall. 

The plaintiffs — state Sen. Mary Elizabeth Coleman, state Rep. Hannah Kelly, anti-abortion activist Kathy Forck and shelter operator Marguerite Forrest —are being represented by Mary Catherine Martin, an attorney with the Thomas More Society.

All but Forrest were part of a lawsuit last year challenging the estimated cost of a proposed constitutional amendment ending the abortion ban.

Missourians for Constitutional Freedom, the campaign behind the amendment, turned in more than 380,000 signatures from Missouri voters across the state, clearing the threshold to earn a place on the statewide ballot, where it needs a simple majority to pass. 

Amendment 3 would establish the constitutional right to an abortion up until fetal viability and grant constitutional protections to other reproductive health care, including in-vitro fertilization and birth control. It would also protect those who assist in an abortion from prosecution. 

Martin argued Friday that the amendment illegally includes more than one subject, pointing to language protecting “a person’s fundamental right to reproductive freedom” and saying such a phrase encompasses “infinite subjects.”

She contends the amendment could have further-reaching effects that it doesn’t specify, including on Missouri’s current laws prohibiting human cloning, prohibiting the creation of a pre-implanted embryo through in-vitro fertilization solely for the purpose of stem cell research and prohibiting minors from getting gender-affirming health care. 

While none of the above issues are specifically mentioned in the amendment, Martin said she believes they still fall under its scope.

“We believe and think it’s pretty evident that cloning and reproductive technologies are matters related to reproductive health care,” Martin said. 

Loretta Haggard, an attorney representing the campaign supporting the amendment, said trying not only to imagine, but also to list, every law that could be affected by the amendment would be “impossibly burdensome.”  

While Amendment 3 would substantially alter the existing ban, Haggard said what current laws it applies to will need to be determined on a case-by-case basis.

“At most there is speculation about how and to what extent Amendment 3 will affect the existing constitutional ban on human cloning.” Haggard said. “Those disputes need to be decided by courts in future cases in light of specific facts with controversies, not by this court.” 

Haggard said the amendment’s single subject and central purpose is clear: “reproductive freedom.”

Martin also claimed the campaign behind the amendment fell short of the law by failing to list the specific laws or constitutional provisions which would be repealed if the amendment is approved by voters. 

Missouri law requires that initiative petitions “include all sections of existing law or of the constitution which would be repealed by the measure.” 

“No one disputes,” she said, “one of its primary purposes and effects is to repeal Missouri’s ban on abortion.” 

Speculation isn’t necessary to come to this conclusion, Martin said, pointing to the ballot summary which reads, in part, that a yes vote would “remove Missouri’s ban on abortion.”

Haggard contends that while the amendment would supersede existing law, it would not erase it from the current constitutional text, and therefore would not truly repeal the current statute. She said this is because the two texts do have some overlapping similarities: both protect women who get abortions from prosecution and both restrict abortion after the point of fetal viability. 

Fetal viability is an undefined period of time generally seen as the point in which the fetus could survive outside the womb on its own, generally around 24 weeks, according to the American College of Obstetricians and Gynecologists.  

When it comes to everything else, Haggard said, the amendment would leave the current law to be interpreted through the lens of the new law, meaning any restrictions implemented by the government on abortion prior to fetal viability will have to withstand strict scrutiny in court to remain. She ventured that most of Missouir’s current restrictions would not survive for this reason.

“The measure writes a road map,” she said, “and it’s up to courts and parties in concrete cases to apply those rules in the future.” 

Following the hearing, Tori Schafer, an attorney with the ACLU of Missouri, stood outside the courthouse alongside a few dozen people waving signs in support of the amendment.  

“The most pressing question for the judge right now is ‘does it make legal sense to kick something off the Friday before ballots are to be printed on a Tuesday?’” she asked.” And the answer to that is no.”

Martin said time will tell. 

“Whatever does happen, surely both parties intend to seek whatever review is available by Tuesday and then on into the future,” Martin said outside the courtroom. “This will not be the last day, no matter what happens.” 

This story may be updated.

Missouri Secretary of State Jay Ashcroft joined the Midwest March for Life on May 1 at the Missouri State Capitol (Anna Spoerre/Missouri Independent).

Missouri Secretary of State Jay Ashcroft has been ordered to remove his characterization of an abortion rights amendment from his government website after a judge deemed it was unfair and violated state statute.

A Cole County judge on Thursday ruled that Ashcroft’s “fair ballot language” summary of the reproductive rights amendment, also known as Amendment 3, was “unfair, inaccurate, insufficient and misleading.”

“Intentionally or not, the secretary’s language sows voter confusion about the effects of the measure,” Circuit Judge Cotton Walker wrote in a Thursday afternoon decision. 

The day Ashcroft certified the abortion-rights amendment for the Nov. 5 ballot, a “fair ballot language” summary for Amendment 3 was also published on his office’s government website. That summary will also appear at every polling place around the state next to sample ballots. By state law this summary must be “true and impartial.”

Ashcroft is vocal in his opposition to abortion.

Amendment 3, if passed by a statewide majority vote, would establish the constitutional right to an abortion up to the point of fetal viability. Since the overturning of the U.S. Supreme Court decision to overturn Roe v. Wade in June 2022, nearly all abortions became illegal in Missouri, with limited exceptions for the life and health of the mother. 

It would also enshrine other reproductive rights in the constitution, including in-vitro fertilization and birth control, both of which remain legal in Missouri. 

Ashcroft’s summary of the amendment read: “A ‘yes’ vote will enshrine the right to abortion at any time of pregnancy in the Missouri Constitution. Additionally, it will prohibit any regulation of abortion, including regulations designed to protect women undergoing abortions and prohibit any civil or criminal recourse against anyone who performs an abortion and hurts or kills the pregnant women.” 

Abortion-rights activists in a lawsuit filed two weeks ago called Ashcroft’s summary of the amendment harmful and confusing to voters.

Walker agreed, ruling that Ashcroft’s assertion that the amendment would allow the right to an abortion at any point in pregnancy “gives voters the wrong idea of what the amendment will accomplish.”

The secretary of state’s office said in a statement that it is reviewing the judge’s decision. 

“Secretary Ashcroft will always stand for life and for the people of Missouri to know the truth,” JoDonn Chaney, a spokesperson for Ashcroft, said Thursday afternoon.

Walker’s decision came a day after a bench trial in which both sides argued over what the amendment would mean for Missourians if approved by voters. 

The brief trial was focused on language around provider immunity.

The amendment reads, in part, that no person “assisting a person in exercising their right to reproductive freedom with that person’s consent be penalized, prosecuted, or otherwise subjected to adverse action for doing so.”

Andrew Crane, a lawyer representing Ashcroft on behalf of the attorney general’s office, argued Wednesday that the amendment would lead to “effectively neutering the government’s ability to enforce any effective regulations” on abortion. 

Such a claim was “politically-charged” and unfounded, since it fails to take into account other language in the amendment protecting patients, said Tori Schafer, an attorney with the ACLU of Missouri, which is representing the plaintiff.

Walker wrote that Ashcroft’s argument runs “contrary to the language of the amendment and will give voters the mistaken impression that the amendment will allow physicians to perform abortions negligently or criminally.” 

The judge said Ashcroft’s argument of provider immunity “ignores, with respect to health care providers, that the protection from prosecution (1) hinges on the patient’s consent and (2) is coextensive with the right to reproductive freedom and its regulation.” 

Walker on Thursday provided new “fair ballot language” to be posted on the secretary of state’s website and at polling places. It reads: 

“A ‘yes’ vote establishes a constitutional right to make decisions about reproductive health care, including abortion and contraceptives, with any governmental interference of that right presumed invalid; removes Missouri’s ban on abortion; allows regulation of reproductive health care to improve of maintain the health of the patient; requires the government not to discriminate, in government programs, funding, and other activities, against persons providing or obtaining reproductive health care; and allows abortion to be restricted or banned after fetal viability except to protect the life or health of the woman.”

The Amendment 3 lawsuit was filed by retired physician Dr. Anna Fitz-James, who initially filed the abortion rights initiative petition in spring 2023 on behalf of Missourians for Constitutional Freedom, the campaign behind the amendment. 

“Missourians deserve the chance to vote on Amendment 3 based on facts,” Rachel Sweet, campaign manager for Missourians for Constitutional Freedom, said in a statement following the decision. “And today’s decision brings us one step closer to making that a reality.”

Walker’s decision mirrored one made by Cole County Circuit Judge Jon Beetem last year, after Ashcroft was also sued by the abortion-rights campaign over the initial ballot summary he drafted, which would have asked Missourians, in part, if they wanted to “allow for dangerous, unregulated, and unrestricted abortions, from conception to live birth.” 

Beetem in his ruling a year ago said that Ashcroft’s language was “problematic” and inaccurate. 

Ashcroft appealed, but the higher court sided with Beetem, writing it is “not a probable effect” that the amendment would allow unrestricted abortion in all nine months of pregnancy or that it would toss aside health and safety regulations, “including requirements that physicians perform abortions and that they maintain medical malpractice insurance.”

A second lawsuit regarding Amendment 3 will be challenged at a bench trial on Friday in Cole County after a number of anti-abortion activists and lawmakers asked a judge to block the amendment from the Nov. 5 ballot. Their lawsuit claims Amendment 3 violates the state constitution by including more than one subject and fails to specify which laws and constitutional provisions would be repealed if it was approved.

Cole County Circuit Court Judge Cotton Walker listens to arguments during a Sept. 8, 2022, hearing (pool photo courtesy of Emily Manley/Nexstar Media Group).

A judge could decide as early as Thursday whether Missouri Secretary of State Jay Ashcroft’s “fair ballot language” summary for an abortion-rights amendment is truly fair. 

Missouri voters will be asked on Nov. 5 whether they support Amendment 3, which would establish a constitutional right to an abortion up until fetal viability and protect other reproductive rights, including access to in-vitro fertilization and birth control. Abortion became illegal in Missouri in June 2022, with limited exceptions for the life and health of the mother.

Posted at every polling station around the state, next to sample ballots, is “fair ballot language” that summarizes the questions that voters will be asked to decide on. State law requires that this language, written by the secretary of state, be “true and impartial.”

In a lawsuit filed two weeks ago, organizers behind Amendment 3 claimed that Ashcroft’s summary was “intentionally argumentative” and could create confusion among voters. 

The same day Ashcroft certified the measure for the November ballot, his office also published to its website a “fair ballot language” summary statement for the amendment which reads: 

“A ‘yes’ vote will enshrine the right to abortion at any time of pregnancy in the Missouri Constitution. Additionally, it will prohibit any regulation of abortion, including regulations designed to protect women undergoing abortions and prohibit any civil or criminal recourse against anyone who performs an abortion and hurts or kills the pregnant women.” 

Missouri voters will decide whether to legalize abortion in November 

The abortion rights campaign is asking the court to issue new “fair ballot language” and order that Ashcroft remove his current language from his government website.

A brief bench trial Wednesday afternoon in Cole County Circuit Court focused in particular on the last sentence of Ashcroft’s summary, and how a court could interpret subsection 5 of the amendment, which reads: “No person shall be penalized, prosecuted, or otherwise subjected to adverse action based on their actual, potential, perceived, or alleged pregnancy outcomes, including but not limited to miscarriage, stillbirth, or abortion. Nor shall any person assisting a person in exercising their right to reproductive freedom with that person’s consent be penalized, prosecuted, or otherwise subjected to adverse action for doing so.”

Andrew Crane, representing Ashcroft on behalf of the Missouri Attorney General’s Office, argued Wednesday that this subsection would result in “effectively neutering the government’s ability to enforce any effective regulations” on abortion. 

Tori Schafer, an attorney with the ACLU of Missouri, which is representing the plaintiff, called this claim “politically-charged” and unfounded, as it fails to take into account other language in the amendment protecting patients.

“The amendment will provide greater independence from the government,” she told the court. “But it does not create the boundless, limitless, unregulated right the secretary continues to make it to be.” 

Schafer said Ashcroft in the latest language “resurrects his false claims” that have already been denounced by the Missouri Court of Appeals.

Ashcroft was sued last year by the abortion-rights campaign over the initial ballot summary he drafted, which would have asked Missourians, in part, if they wanted to “allow for dangerous, unregulated, and unrestricted abortions, from conception to live birth.” 

Cole County Circuit Judge Jon Beetem ruled a year ago that Ashcroft’s language was “problematic” and inaccurate. 

An appeals court agreed, ruling that it is “not a probable effect” that the amendment would allow unrestricted abortion in all nine months of pregnancy or that it would toss aside health and safety regulations, “including requirements that physicians perform abortions and that they maintain medical malpractice insurance.”

However, Crane on Wednesday argued that the appeals court ruling didn’t specifically address the immunity provisions of subsection 5.

Ashcroft, who recently lost a bid for the GOP candidate for governor, has been open about his opposition to abortion. 

During the Midwest March for Life outside in May, he told The Independent of the abortion initiative petition: “I just want to make sure that people know what this amendment will actually do. That it’s abortion from conception until the very last second that the last toenail leaves the birth canal.”

Cole County Circuit Judge Cotton Walker, who is overseeing the current case, said he intends to rule on Thursday. 

Walker recently upheld the “fair ballot language” summary written by Ashcroft for a proposed constitutional amendment that would ban ranked-choice voting after two voters sued over the language. The voters called the language imprecise, in part because it doesn’t state that it’s currently illegal for non-citizens to vote in Missouri. 

The Amendment 3 lawsuit was filed by retired physician Dr. Anna Fitz-James, who initially filed the abortion rights initiative petition in spring 2023 on behalf of Missourians for Constitutional Freedom, the campaign behind the amendment. 

The campaign has raised millions of dollars this election cycle, and recent polling by St. Louis University/YouGov showed 52% of Missouri voters supported Amendment 3. The poll surveyed 900 voters across nine days in August.

Meanwhile, a second lawsuit regarding Amendment 3 is also pending in Cole County after a number of anti-abortion activists and lawmakers asked a judge to block the amendment from the Nov. 5 ballot. Their lawsuit claims Amendment 3 violates the state constitution by including more than one subject and fails to specify which laws and constitutional provisions would be repealed if it was approved.

A bench trial in that lawsuit is scheduled for Friday.

Missouri Secretary of State Jay Ashcroft joined the Midwest March for Life on May 1 at the Missouri State Capitol. “I think regardless of what the legislature does, the people of this state – with hard work – can protect all life in this state," Ashcroft said (Anna Spoerre/Missouri Independent).

Organizers behind an abortion-rights amendment that will appear on Missouri’s November ballot filed a lawsuit last week alleging the “fair ballot language” written by the secretary of state’s office  is “intentionally argumentative” and bound to create confusion for voters.

Amendment 3 asks voters if they want to legalize abortion up until the point of fetal viability. Abortion has been illegal in Missouri, with only limited exceptions for the life and health of the mother, since June 2022.

Missouri Secretary of State Jay Ashcroft certified the measure for the ballot last week. On the same day, the office published on its website the amendment’s fair ballot language statement, which is meant to be posted at every polling place next to the sample ballot. 

The language listed on the secretary of state’s website as of Tuesday reads: “A ‘yes’ vote will enshrine the right to abortion at any time of pregnancy in the Missouri Constitution. Additionally, it will prohibit any regulation of abortion, including regulations designed to protect women undergoing abortions and prohibit any civil or criminal recourse against anyone who performs an abortion and hurts or kills the pregnant women.” 

“These politicians know that Missouri voters overwhelmingly support Amendment 3,” Rachel Sweet, campaign manager with Missourians for Constitutional Freedom, said in a statement. “So they resort to deceptive and misleading tactics.” 

Dr. Anna Fitz-James, the named plaintiff in the lawsuit, labeled Ashcroft’s language “unfair, insufficient, inaccurate, misleading, argumentative, prejudicial.” 

Fitz-James, a retired physician who lives in Missouri, first filed the abortion rights initiative petition in March 2023 on behalf of Missourians for Constitutional Freedom, the campaign behind the ballot measure which has raised several million dollars this year.

“Missourians are entitled to fair, accurate, and sufficient language that will allow them to cast an informed vote for or against the Amendment without being subjected to the Secretary of State’s disinformation,” according to the lawsuit filed in Cole County, which was first reported by the St. Louis Post-Dispatch. 

Ashcroft, who recently finished third in the GOP primary for governor, has been vocal in his opposition to abortion.

“I am appalled that factions want to use the courts to misrepresent the truth to push a political agenda,” Ashcroft said in a statement Tuesday in response to the lawsuit, which also accuses him of pushing a political agenda. “I will always fight for the right of Missourians to have clear, understandable ballot language when they vote on such an important fundamental issue as life.”

The abortion rights campaign is asking the court to issue new fair ballot language and order that Ashcroft remove his current language from the government website. A court date has not yet been set.

This isn’t the first time the campaign has sued Ashcroft over the ballot measure. 

The initial ballot summary he drafted to appear on the ballot would have asked Missourians, in part, if they wanted to “allow for dangerous, unregulated, and unrestricted abortions, from conception to live birth.” 

A Missouri judge in September ruled Ashcroft’s language was “problematic” and inaccurate.

Ashcroft appealed the ruling, but the Missouri Supreme Court denied to take up the case. 

The new ballot language — approved by Missouri courts — will ask voters if they want to: 

• establish a right to make decisions about reproductive health care, including abortion and contraceptives, with any governmental interference of that right presumed invalid;

• remove Missouri’s ban on abortion;
• allow regulation of reproductive health care to improve or maintain the health of the patient;
• require the government not to discriminate, in government programs, funding, and other activities, against persons providing or obtaining reproductive health care; and

• allow abortion to be restricted or banned after Fetal Viability except to protect the life or health of the woman?

Attendees cheer during a Missourians for Constitutional Freedom rally after the campaign turned in more than 380,000 signatures for its initiative petition to enshrine abortion rights in Missouri’s constitution Friday morning (Annelise Hanshaw/Missouri Independent).

Abortion will be on Missouri’s statewide ballot in November.

An initiative petition to enshrine the right to abortion up until the point of fetal viability received final approval Tuesday, securing a place on the general election ballot. If the measure receives a majority of votes, Missouri could become the first state to overturn an abortion ban through a citizen-led measure.

The Missouri Secretary of State’s Office had until 5 p.m. to certify all ballot measures that received enough verified signatures to qualify. It certified the measures as sufficient hours before that deadline. Also certified to be on the November ballot were proposals to legalize sports wagering and raise the minimum wage. 

Leaders with Missourians for Constitutional Freedom, the coalition behind the ballot measure, gathered at a press conference Tuesday to encourage Missourians to get out to vote. The coalition is headed by Abortion Action Missouri, the ACLU of Missouri and the state’s Planned Parenthood affiliates. 

“Politicians have tied doctors’ hands and the stakes could not be higher,” said Mallory Schwarz, executive director of Abortion Action Missouri. “ … With a yes vote on amendment 3 this November, we are taking back what’s ours.”

In Missouri, the first state to ban abortion after the U.S. Supreme Court overturned the constitutional right to the procedure two years ago, abortion is expected to be a focal point of the general election campaign.

Missouri is among 18 states with an abortion ban, and among several states working to put abortion on the ballot. In each state that put the issue on the ballot, citizens ultimately choose to protect the procedure.

“The measure takes away the right from every person who loses a child or a loved one because of negligence during pregnancy, labor or delivery the freedom to sue for malpractice and obtain compensation,” Stephanie Bell, a spokeswoman with Missouri Stands with Women, said in a statement Tuesday.

Tori Schafer, director for policy and campaigns for the ACLU of Missouri, responded to the comment, saying the statement is “fully false” and that the amendment doesn’t impact malpractice laws already in place.

What would the amendment do?

Abortion is illegal in Missouri, with limited exceptions only in cases of medical emergencies. There are no exceptions for survivors of rape or incest.

If the amendment receives more than 50% of votes in approval, the measure would legalize abortion up until the point of fetal viability, an undefined period of time generally seen as the point in which the fetus could survive outside the womb on its own, generally around 24 weeks, according to the American College of Obstetricians and Gynecologists. 

Such an amendment would return Missouri to the standard of the 1973 Roe v. Wade decision, which also legalized abortion up to the point of fetal viability. Missouri’s amendment also includes exceptions after viability “to protect the life or physical or mental health of the pregnant person.”

Missouri’s amendment also states that women and those performing or assisting in abortions cannot be prosecuted. Under current Missouri law, doctors who perform abortions deemed unnecessary can be charged with a class B felony and face up to 15 years in prison. Their medical license can also be suspended or revoked.

Dr. Selina Sandoval, associate medical director for Planned Parenthood Great Plains Votes, said the right to make decisions about abortion is personal and she sees each day the barriers and hardships bans cause.

“In Kansas right now, we are serving mostly out-of-state patients, including Missourians, who’ve had to flee their home states in order to simply access abortion care,” Sandoval said Tuesday.

Missourians for Constitutional Freedom, the coalition leading the reproductive-rights campaigns, is headed by Abortion Action Missouri, the ACLU of Missouri and the state’s Planned Parenthood affiliates. 

A decade ago, when abortion was still legal with fewer limitations, more than 5,000 abortions were performed in the state, according to data from the Missouri Department of Health and Senior Services. But by 2020, that number dropped to 167 due to a series of “targeted regulation of abortion providers” laws passed, including a mandatory 72-hour waiting period between the initial appointment and a surgical abortion and mandatory pelvic exams for medication abortions.

2 years after Missouri banned abortion, navigating access still involves fear, confusion

Since the Supreme Court decision in June 2022 through March 2024, there were 64 abortions performed in Missouri under the state’s emergency exemption, according to data from the Missouri Department of Health and Senior Services. 

A recent study by the Guttmacher Institute, a reproductive rights research group, showed that in 2023 alone, 8,710 Missourians traveled to Illinois and 2,860 Missourians went to Kansas for the procedure, which remains legal in both states. 

Despite the relative proximity to clinics in the Illinois suburbs of St. Louis and the Kansas suburbs of Kansas City, abortion access for Missourians has remained precarious at best.

Missourians hoping for abortions have increasingly found themselves competing for limited resources — including abortion funds and clinic appointment openings — especially as more southern states have outlawed the procedure, making Illinois and Kansas critical access points for women in states like Florida, Oklahoma and Texas. 

This has led many Missourians to increasingly rely on self-managed medication abortions. Rather than traveling across state lines, it’s estimated that thousands of Missourians received Mifepristone and Misoprostol to end their pregnancies at home in the past two years according to JAMA, the American Medical Association’s journal.

On Tuesday, members of Missourians for Constitutional Freedom continued to return to their continued fears for women’s health care in Missouri if a ban remains in place. Missouri already has stark maternal health care deserts, high maternal mortality rates, and recently saw a decrease in applicants to OB-GYN residency programs.

Schafer, with the ACLU, said the coalition plans to start rebuilding access to abortion on day one, if the measure passes.

“We know that after passage, constitutional amendments take 30 days to go into effect in the state of Missouri,” she said. “And we are hopeful that clinics will be open and our teams will be working toward that as our goal.”

Schwarz said they’ve been in contact with abortion providers about coming back to Missouri.

“After we win this in November, the impact will be regional and across the country,” she said. “And and from abortion providers that we are in close regular relationship and contact with, people are thinking all the time about where the next clinic can be, where the next opportunity is for them to grow and be able to support more and more patients.”

Wide support despite initial delays

The initial attempt to place abortion on the ballot began in March 2023. 

Legal fights with Republican state officials over the ballot language and internal disagreements on whether to include a viability ban stalled signature gathering attempts until January. 

As a result, the coalition had just 90 days to fundraise and collect signatures across the state.  

Meanwhile, Republican lawmakers were prioritizing an attempt to raise the threshold for approving citizen-led ballot measures. After a series of Senate filibusters, including one that broke records at 41 hours, the legislation failed on the final day of session. 

Missouri House Speaker Dean Plocher on the day of adjournment said that if abortion made it to the ballot and then passed in November under the current initiative petition guidelines, “the burden of abortion falls squarely on the Senate and its leadership.”

Despite these obstacles, the initiative petition garnered wide support across the state. 

As of July, the campaign raised nearly $7.3 million in donations, according to filings with the Missouri Ethics Commission.

Missourians for Constitutional Freedom turned in 380,000 signatures by their May deadline, including from each of Missouri’s 114 counties. To qualify for the ballot, they had to get signatures from 8% of registered voters in six of Missouri’s eight congressional districts, which equates to about 171,000 signatures.  

As of mid-July, the campaign had turned in more than enough valid signatures to land on the ballot, according to preliminary records from Missouri election authorities.

Once all verified signatures were turned in by election authorities in late July, the secretary of state’s office had two weeks to determine whether there were any final issues, like duplicate pages or missing affidavits signed by circulators. 

On Tuesday, the secretary of state’s office also certified ballot measures hoping to raise the state’s minimum wage and mandate paid sick leave and legalize sports wagering. A third proposal to authorize construction of a new casino near Lake of the Ozarks fell short of the needed signatures.  

This story was updated at 2:30 p.m. to include reactions from those supportive of and opposed to the amendment.

Missouri Attorney General Andrew Bailey delivers a victory speech to supporters in Columbia after winning the primary election against Republican attorney general hopeful Will Scharf on Tuesday (Anna Spoerre/Missouri Independent).

COLUMBIA — Missouri Attorney General Andrew Bailey survived a tough primary challenge from a member of former president Donald Trump’s legal team on Tuesday to win the GOP nomination for a full term in office. 

His opponent, Will Scharf, conceded the race shortly before 8:30 p.m. with Bailey leading 62% to 37%. Bailey soon addressed a crowd of supporters at the Stoney Creek Hotel in Columbia.

Taking the stage with his young son in one arm, Bailey raised his fist and deepened his voice.

“Tomorrow, when reveille sounds,” Bailey said, speaking about himself in third person, “Andrew Bailey will grab his rucksack and his rifle and will stand in formation with other conservative leaders as we march on to victory in November.”

Bailey has held the office since November 2022, when he was appointed attorney general by Gov. Mike Parson after his predecessor Eric Schmitt won a U.S. Senate seat. At the time Bailey was Parson’s general counsel and had no experience in elected office. 

An Army veteran and former assistant prosecutor, Bailey has said much of his career has been shaped by his time as an assistant prosecutor and county juvenile office in Missouri. He and his wife went on to foster and then adopt three of their four children.

“I am committed to serving the people of this state and delivering transformative, conservative change,” he told a cheering crowd Tuesday. 

Bailey promised to continue fighting the Biden administration and strengthening consumer protection.

His most high-profile cases since becoming attorney general include twice suing to block federal student loan forgiveness, and carrying forward a lawsuit alleging the Biden administration was censoring conservatives online by pressuring social media companies. 

Bailey has also touted awarding $32 million in settlements and judgments on behalf of defrauded Missourians through his office’s Consumer Protection Division.

Dorothy Berry, 71, said she was upset when Parson appointed Bailey instead of former state Sen. Kurt Schaefer, whom she favored. Berry kept a close eye on Bailey, ready to make a list of his mistakes. But at the end of the day, she said she couldn’t find any to write home about.

She said she agreed with Bailey’s role in the closure of Washington University Transgender Center at St. Louis Children’s Hospital and his push to drive former St. Louis Circuit Attorney Kim Gardner out of office. 

Berry, who spent more than two decades working for Missouri lawmakers, said she also liked that Bailey spent much of his childhood in Missouri. 

“He graduated from Rock Bridge High School,” Berry said. “He’s not some St. Louis or Kansas City millionaire.”

Bailey on the campaign trail often rebuked Scharf as “Wall Street Willie.” Scharf, who grew up in New York and graduated from Princeton University and Harvard Law School, moved to Missouri in 2011. 

Meanwhile, PACs backing Scharf spent millions attacking Bailey’s record. Scharf’s campaign committee and associated PAC raised $9 million in the campaign, including from influential conservative activist Leonard Leo. Bailey raised $4.1 million.

Bailey has faced accusations of corruption, incompetence and grandstanding, with his critics alleging he’s more interested in scoring appearances on Fox News than effectively running the sprawling office or winning in the courtroom.

Bailey recused himself from a gambling lawsuit filed against the Missouri State Highway Patrol after PACs connected to the lobbyist of the companies suing the state wrote checks to the committee supporting Bailey’s campaign. 

He was also criticized for accepting $50,000 in campaign donations from Doe Run, a St. Louis-based company being sued by thousands of Peruvians over allegations of lead smelter poisoning in their mining town in the Andes. A few months before the donation, Bailey filed a brief asking the federal court to move the lawsuit out of Missouri.

Just this week, the U.S. Supreme Court rejected Bailey’s attempts to delay the sentencing hearing in Trump’s hush money case in New York, which is scheduled for September.

Julie Engelbrecht, a Scharf supporter from Ladue who attended his watch party, said she believes Scharf’s legal successes are “lengths ahead” of Bailey’s, noting several cases Bailey lost, and several attorneys who’ve left his office. 

But in the end, Bailey benefited from a late endorsement of both candidates by Trump, taking away one of Scharf’s most potent campaign messages — his close ties to the former president. 

Bailey also enjoyed late support from Parson, who even used his official office to boost the attorney general in the campaign’s final days. 

Early Tuesday evening, Scharf told The Independent he was hoping for a long night, meaning a close race.

That didn’t come to fruition. An hour into vote counting, his corner of campaign staff looked concerned, hunching over laptops in a corner of Krueger’s bar in Clayton.

Scharf during a concession speech a short time later said he called Bailey to concede and offer his full support in the general election. 

“I’m not going anywhere,” Scharf said Tuesday night. “I intend to continue chalking up wins for President Trump and for the conservative movement in the months and years ahead. I’m just deeply sorry that I won’t be doing that as the state’s next attorney general.” 

Bailey later tipped his hat to Scharf’s tough-fought campaign. 

“This is someone who’s worked for President Trump in the past, and he pledged his support in the future,” he said, “and I’m excited to look for ways to partner in the future to move the state in a good direction.” 

Bailey will face Democratic candidate Elad Gross in the November general election. Gross, a former assistant attorney general who runs a St. Louis law firm, has been an outspoken champion of Sunshine law and, like Scharf, a fierce critic of Bailey.

Bailey’s speech was brief, ending when his son polished off his cookie. 

“That’s my signal,” Bailey said, “to cease and desist.”

Mylissa Farmer shares her story for a 2022 TV ad for Democratic Senate candidate Trudy Busch Valentine (screenshot).

Two years ago, Mylissa Farmer was denied an emergency abortion at hospitals in Missouri and Kansas while experiencing a miscarriage. 

On Tuesday, she filed a lawsuit against one of the hospitals — The University of Kansas Health System — accusing the hospital of sex discrimination and saying it violated a federal law meant to ensure doctors treat patients who come into the emergency room. 

A spokesperson with the health system did not immediately respond to a request for comment.

“While Ms. Farmer was clearly in the midst of a complicated and dangerous miscarriage — and there was no chance her fetus could survive — the care she needed was an abortion because fetal cardiac activity was still detectable,” states the lawsuit filed in Kansas federal court. “Ms. Farmer was entitled to this emergency abortion care under state and federal law.”

Farmer was living in southwest Missouri when she miscarried. Several weeks earlier, Missouri banned abortion in the wake of the U.S. Supreme Court overturning the constitutional right to the procedure. 

The day she went to an emergency room — cramping and bleeding at 18 weeks pregnant — Kansas voters were heading to the polls to vote in favor of keeping abortion legal in that state.

Farmer went to the emergency room at Freeman Health’s emergency department in Joplin at her OB-GYN’s urging. There, medical staff determined the pregnancy was no longer viable, but because the fetus had a heartbeat, and because Farmer’s condition wasn’t immediately life-threatening, she was turned away. 

Hospitals in Joplin, KCK cited for denying emergency abortion to Missouri woman

According to the lawsuit, doctors told Farmer that she was at risk of infection, severe blood loss, the loss of her uterus and death. But they would not help her because of Missouri’s abortion ban, which had only been in place for several weeks, outlawing all abortions with limited exceptions in cases of medical emergencies. 

Farmer then traveled three hours across the border to a hospital in Kansas, where abortion is limited after 22 weeks gestation. However, doctors at the University of Kansas Health System also refused to perform an abortion. Kansas law bans abortions at any facilities run by the University of Kansas Hospital Authority, with exemptions for the life and health of the mother.

“Ms. Farmer arrived at (the University of Kansas Health) heartbroken, in pain and terrified for her life,” the lawsuit reads.

The doctor who saw Farmer initially told her the hospital would induce labor so Farmer could then hold her daughter and say goodbye, according to the lawsuit. But the doctor later said her decision had been overridden by others at the hospital, and that she could no longer induce labor because it would be too “risky” in Kansas’ “heated” political environment to do so when the fetus still had a heartbeat.

Instead, according to the suit, the hospital refused to even perform routine checks such as taking her temperature and assessing her pain. She was turned away without so much as Tylenol or antibiotics to ward off potential infection despite Farmer being at high risk for infection and experiencing heavy bleeding, mental fog and acute pain. 

She returned to the Joplin hospital the next day, was kept overnight and then released without additional treatment.

Farmer eventually traveled several hours to Hope Clinic in Granite City, Illinois, for an abortion on Aug. 5. On the drive there, according to the suit, she was in excruciating pain, by then several days into her miscarriage and almost fully dilated.

Back home after the abortion, Farmer’s OB-GYN diagnosed her with an infection and prescribed her antibiotics.

The damage to Farmer’s health and wellbeing was long-term, the lawsuit argues. She was hospitalized several times after the miscarriage, and was unable to work for months. She eventually lost her home and moved out of Missouri.

What Farmer experienced at the Kansas hospital “compounded the trauma of her pregnancy loss and denied her the ability to mourn that loss on her own terms,” the suit reads.

Farmer, who has a history of polycystic ovary syndrome, had feared she and her husband would not be able to get pregnant prior to the summer of 2022, the lawsuit reads.

Her story caused national outrage as women and providers in states with abortion bans and restrictions navigated new and often vague laws. Under Missouri’s new ban, health care providers who perform abortions that weren’t deemed medical emergencies can be charged with a class B felony. If convicted, they would face up to 15 years in prison and their medical license could also be suspended or revoked.   

In a letter to the hospitals several months later, U.S. Secretary of Health and Human Services Xavier Becerra warned that both locations had to provide all necessary care required by federal law. A report by the Centers for Medicare and Medicaid Services found both hospitals had violated the Emergency Medical Treatment and Labor Act. 

This act, known as EMTALA, requires that hospitals treat patients with emergency conditions despite their ability to pay. 

“Although her doctors advised her that her condition could rapidly deteriorate, they also advised that they could not provide her with the care that would prevent infection, hemorrhage, and potentially death because, they said, the hospital policies prohibited treatment that could be considered an abortion,” Becerra wrote in May 2023. “This was a violation of the EMTALA protections that were designed to protect patients like her.”

The federal lawsuit comes in the wake of an Idaho EMTALA case recently argued before the U.S. Supreme Court. While awaiting the decision, thousands of doctors, including dozens across Missouri, asked the court to uphold EMTALA.  

Emergency care for pregnant women at stake in Supreme Court case, Missouri doctor warns

The nation’s highest court sent the case back down to the court of appeals. Earlier this year, several women with high-risk pregnancies were airlifted to other states in order for emergency physicians to avoid performing emergency abortions in a state with a ban on the procedure.

Unlike the Idaho case, which was brought by the government, Farmer’s is the first high profile EMTALA lawsuit brought after the fall of Roe by an individual denied an emergency abortion, said Kenna Titus, a legal fellow with the National Women’s Law Center, the organization representing Farmer.

“In the post-Dobbs world, we know that these protections that are provided by EMTALA for pregnant people are more important than they’ve ever been,” Titus said. “A clear decision in this case will make it clear for people across the country that are dealing with this that this is not a gray area. Federal law requires abortion care in emergency situations like this.”

As of Wednesday, no lawsuit had been filed in federal court against the Joplin hospital.

Missouri continues to higher rates of maternal and infant mortality, breast and cervical cancer deaths and preterm births, according to a study from the Commonwealth Fund (Getty Images).

Missouri women have more limited access to health care and worse outcomes than any other state in the Midwest, a new study of the nation’s health care system found. 

Missouri ranks 40th out of 51 states plus the District of Columbia on the 2024 state scorecard on women’s health and reproductive care, published by the Commonwealth Fund, a private foundation focused on health care issues.

The study assessed and compared 32 pieces of information derived primarily from public data sources in 2022, which was after most of the major effects of COVID had been felt, but before most abortion bans had really started to impact data findings, the creators of the scorecard said.

Missouri continues to see maternal and infant mortality rates, breast and cervical cancer death rates, preterm births, congenital syphilis and depression leading up to or during pregnancy at rates that are higher than the national average. 

There are more women in Missouri between the ages of 18 and 44 reporting they hadn’t seen a doctor in the past year because of the cost than all but 10 other states. 

“One thing is absolutely clear,” Joe Betancourt, president of the Commonwealth Fund, told reporters when the study was published last week. “Women’s Health in the U.S. is in a very fragile state.”

Missouri ranked among the states with the lowest low-risk c-section rates, postpartum depression and up-to-date pneumonia vaccines for post-menopausal women. But it fared among the worst nationally for breast and cervical cancer deaths, up-to-date pap smears, and mental health among women ages 18 to 64.

It also ranked poorly when analyzing access to abortion clinics. Nearly every abortion became illegal in Missouri in 2022. A citizen-led ballot measure is hoping to enshrine abortion rights in the Missouri constitution. 

“We are seeing a deep and likely growing geographic divide in U.S. women’s ability to access vital health services and maintain their health,” said Sara Collins, a co-author on the Commonwealth Fund study. “Particularly among women of reproductive age.”

Ashley Kuykendall, director of service delivery for the Missouri Family Health Council Inc., a nonprofit working to strengthen health care access across the state, said one of the most stark findings of the report was the combination of lack of access to wraparound care paired with poor health outcomes.

But solutions exist, she said. 

One such solution: a women’s health omnibus bill that failed to pass in the statehouse this year despite widespread bipartisan support, that would have expanded birth control coverage, increased congenital syphilis testing and eased access to mammograms and STI testing.

“The state legislature has an incredible power and responsibility to support better care for people across the reproductive health spectrum,” Kuykendall said. “Especially, as this report highlights, for folks who are pregnant or postpartum.” 

Health and reproductive care outcomes

Missouri ranked 43 of 51 for this category, which includes maternal and infant mortality and physical and mental health issues. 

Some data was analyzed using the Centers for Disease Control and Prevention’s Pregnancy Risk Assessment Monitoring System.  Missouri is among 33 states who participate in this federal program. Of those states, Missouri had the highest percentage of women who recently gave birth and reported experiencing intimate partner violence before, during or after their pregnancy.

Missouri has some of the highest pregnancy-associated maternal mortality rates in the United States, which already ranks worst among countries of similar economies for high maternal deaths.

In Missouri between 2018 and 2020, women on Medicaid were 10 times more likely to die within a year of pregnancy than women on private insurance, according to a 2023 report from the state’s Pregnancy-Associated Mortality Review. Black mothers were three times more likely to die within a year of pregnancy than white mothers. 

Of the 210 pregnancy-related deaths over those three years in Missouri, the majority were deemed preventable.

Mental health conditions were the leading underlying cause of death, including due to suicide and substance use.

The latest study found Missouri had one of the highest percentages of women between the ages of 18 and 64 who reported poor mental health, landing 48 of 51. 

Coverage, access and affordability

Missouri ranked slightly better — 39 of 51 —  in this category, which includes insurance coverage and health care affordability and access. 

Of the 33 states that provided data around health insurance coverage, Missouri ranked third-worst for women uninsured the month before becoming pregnant, and sixth-worst for women who didn’t have health insurance during a recent pregnancy. 

This is despite Missouri legislators’ decision to expand postpartum Medicaid coverage from 60 days to a year in 2023. 

A better-funded, better-staffed and more accessible public health safety net is also critical, said Kuykendall. 

This summer, Gov. Mike Parson signed into law a bill ending Medicaid reimbursements to Planned Parenthood, including for patients who go to the clinic for preventive exams, family planning and STI testing. Those opposed to the bill warned such a law would strain the state’s already fragile public health safety net.

“The need for these services far outweighs the current capacity for the safety net to provide them,” Kuykendall said. “Any funding cuts to those providers not only limits patients’ ability to access care, but also puts further strain on the health care workforce and will undoubtedly worsen these outcomes.”

Recent surveying by the health care nonprofit found that wait times across the state’s overburdened safety net clinics averaged between five and seven weeks. These 68 clinics receive Title X funding and do not turn anyone away, regardless of their ability to pay.

The study found that approximately 5.6 million women across the country live in counties that are considered maternity care deserts.

In Missouri, 41% of counties are designated maternity care deserts, meaning there are no maternity care providers or birthing facilities. Missouri’s rate is higher than the national rate of 32%, according to a separate 2023 report from the March of Dimes. Across the state, 10% of women do not live within 30 minutes of a birthing hospital.

In the last decade, 19 hospitals across Missouri have closed, according to the Missouri Hospital Association.

“There is an issue of access that’s very real,” Kuykendall said.

The authors of the study were also deliberate in considering outcomes in states with abortion bans and restrictions. 

“There’s concern that abortion bans or limits will further reduce the number of providers offering maternity care owing to increased risk of legal action that provider’s face,” said David Radley, a senior scientist with the Commonwealth Fund. “Especially when states’ laws are ambiguous.”

A recent study showed states with abortion bans saw a significant decrease in the number of medical residents applying to be in their OB-GYN programs.

2 years after Missouri banned abortion, navigating access still involves fear, confusion

Missouri saw a 25% drop in applicants since 2022, the highest drop in the nation second only to Arizona.

“These inequities are long standing, no doubt, but recent policy choices and judicial decisions restricting access to reproductive care have and may continue to exacerbate them, Commonwealth Fund president Betancourt said of the study’s findings when related to states with abortion bans. 

“It also serves as a glaring reminder that where you live matters to your health and health care.”

Health care quality and prevention

Missouri landed in slot 35 of 51 for this category, which includes c-section rates, preventative care, pre and post-partum care and mental health screenings. 

In better news, Missouri ranked 15 of 51 among states with the lowest rates of c-sections during  low-risk births, which Kuykendall attributed in part to the state health department’s increased focus on doula programs.

Missouri was slightly below the national average for the percentage of women eligible for mammograms who underwent the breast cancer screening in the past two years (75%), and the percentage of women ages 21 through 65 who had a pap smear, which screens for cervical cancer, in the past three years (78%).

Among the more concerning data points to Kuykendall was a report that 19% of women between the ages of 18 and 44 in the past 12 months had put off seeing a doctor because of the cost. 

This data resonates with what she hears often from Missourians, who say it can be difficult to access even the most basic health care for reasons including cost, lack of transportation and lack of options.

“It was a positive step that Missouri expanded Medicaid,” Kuykendall said, “And I think we have a long way to go in terms of ensuring everyone who should have access to care in that new environment actually does.”

Jamie Corley, left, and Dean Plocher are two of eight candidates running in the GOP primary for secretary of state (Annelise Hanshaw/Missouri Independent).

Two of the eight Republican candidates for Missouri Secretary of State launched TV campaign ads this week, hoping to break away from the pack in the final two weeks before the Aug. 6 primary.

Jamie Corley, a longtime Republican political operative from St. Louis, was first on the air, launching ads in three markets on Monday. 

Ads for Dean Plocher, the speaker of the Missouri House, hit the airwaves Tuesday.

Plocher — who leads the field of secretary of state hopefuls in fundraising with more than $1.2 million between his campaign and his PAC — has thrown more than $285,000 towards TV ads at stations across the state in the run up to the primary, records show. 

His campaign did not respond to a request for comment on ad spending. 

Corley, who has about $300,000 invested in her campaign, has spent about $23,300 on ads running this week across the state’s largest metro areas. She said in an interview that her campaign also spent $80,000 on digital ads to run on streaming platforms, and that she intends to buy more TV air time next week. 

The other six candidates — state Sen. Mary Elizabeth Coleman, social media personality Valentina Gomez, Greene County Clerk Shane Schoeller, state Sen. Denny Hoskins, state Rep. Adam Schwadron and Judge Mike Carter — have not run any TV ads this cycle thus far. 

Eight Republicans face off in primary to be Missouri’s top election official

Despite being out-fundraised by Plocher, Corley said beating him to getting the first ads on air shows she’s serious about winning. She added her campaign plans to purchase more next week. 

“Dean does have more money than anybody else in the race,” Corley said.” However, I don’t know if he is going to spend all of it. Maybe he’s saving some for legal fees. Maybe he’s spending some for a future campaign. I can tell you that my campaign will be zeroed out.”

Corley is referencing a whistleblower lawsuit against Plocher and his chief of staff, Rod Jetton, in Cole Circuit Court alleging both men harassed and intimidated nonpartisan legislative staff.

The suit stems from a series of scandals that plagued Plocher’s final year as speaker, ranging from an alleged pay-to-play scheme involving a lucrative software contract and revelations he filed false expense reports for travel already paid for by his campaign.

Plocher’s campaign ad doesn’t mention his woes, instead focusing on his legislative record, proclaiming his support for voter ID, citizen-only voting and sending National Guard troops to the border.

“I’m Dean Plocher,” he says in the ad. “As secretary of state, I’ll stand with President Trump to secure our elections and keep Missouri conservative.”

But while Plocher scandals haven’t found their way into TV ads, the PAC supporting Schwadron’s campaign spent $44,000 in the last month on fliers inserted in local newspapers in the St. Louis area highlighting the litany of alleged wrongdoing and declaring “evil triumphs when good men do nothing.” 

Schwadron was among the first Republicans to call for Plocher to resign last year, before Plocher joined the secretary of state primary. In an interview with The Independent, Schwadron said he’s seen nothing in the intervening months to change his mind.

“He should resign,” he said earlier this month. “He does not deserve to be in that office.”

Abortion politics

Corley is also hoping to stand out as the only major Republican candidate running for statewide office to publicly support abortion access. Late last year she launched a campaign seeking to legalize abortion in the first 12 weeks of pregnancy and add exemptions in the law for fetal abnormalities and for victims of rape or incest. 

“The total abortion ban goes too far, and I think it’s going to decimate the maternal health care system,” Corley said Monday.

In her campaigning, Corley has emphasized that she and former president and current GOP nominee Donald Trump are aligned on abortion. At the Republican National Convention earlier this month, delegates adopted a new party platform which fell in line with Trump’s stance that abortion should be left up to each state to decide. The party platform previously supported national restrictions on abortion.

Corley pointed to this change in RNC messaging as one of a few reasons why she will soon be doubling down on her messaging around reproductive rights. 

Later this week, Corley said she will launch a text message campaign emphasizing her stance to 50,000 Missourians.

“We have to protect birth control. We have to protect IVF, and we’re not penalizing women for getting healthcare,” Corley said, adding that she’s optimistic messaging around IVF can help get more suburban Republican women out to the polls. Earlier this year, Missouri lawmakers failed to pass legislation guaranteeing protections to the procedure, though lawmakers on both sides of the aisle have said it remains a priority.

While her digital campaign focuses more heavily on reproductive rights, Corley’s TV ad makes no mention of abortion, instead leaning into more mainstream conservative talking points.

“I believe in building a stronger, safer state for all of us,” she says in the video. “That starts with secure elections, cultivating a pro-business economy and having the backs of our law enforcement.”

The Independent’s Jason Hancock and Rudi Keller contributed to this story.

Petitioners with Missourians for Healthy Families and Fair Wages unload dozens of boxes of signatures on May 1 for delivery to the Secretary of State. (Annelise Hanshaw/Missouri Independent).

Citizen-led ballot measures to enshrine abortion rights in the Missouri constitution and mandate paid sick leave and an increased minimum wage remain on track to make November’s ballot, with records from Missouri election authorities showing each campaign has turned in more than enough valid signatures as the verification process continues. 

Whether the two proposals — or two others pertaining to gambling — succeed at getting on the statewide ballot won’t be known for certain until county election officials finish verifying the signature and the secretary of state certifies their work in the coming weeks.

Each of Missouri’s 114 counties, plus the city of St. Louis, has until the end of July to finish deeming each of the hundreds of thousands of signatures either valid or invalid. Then, the Missouri Secretary of State’s Office has two weeks to certify the ballot measures as sufficient or insufficient. This includes determining whether there were any duplicate pages turned in, or whether any pages were submitted without the required ballot language attached or without an affidavit signed by the circulator. 

Missouri is among several states vying to put abortion on the ballot following the overturning of Roe v. Wade in 2022, at which point nearly every abortion became illegal in Missouri. If approved for the ballot, Missourians will decide in November whether to allow abortions up until the point of fetal viability. 

Missourians for Constitutional Freedom, the coalition leading the reproductive rights campaigns, turned in 380,000 signatures by their May deadline, including from every county. To qualify for the ballot, campaigns must get signatures from 8% of registered voters in six of Missouri’s eight congressional districts, which equates to about 171,000 signatures.

As of Wednesday, the campaign, which is led by Abortion Action Missouri, the ACLU of Missouri and the state’s Planned Parenthood affiliates, had at least a few thousand more verified signatures in each of the six of the eight congressional districts than required. 

The campaign’s strongest showing so far was in District 1, which contains the city of St. Louis and part of St. Louis County. There it needs more than 25,600 signatures, and according to data from election officials there were more than 53,000 signatures deemed valid in the district — despite more than 25,000 signatures being thrown out as invalid.

“We are confident as we await official certification from the Secretary of State,” Tori Schafer, deputy director for policy and campaigns with Missouri ACLU, said in a statement Wednesday. 

Eight Republicans face off in primary to be Missouri’s top election official

Another initiative petition campaign would raise the state’s minimum wage to $13.75 beginning in January 2025 and $15 in 2026, followed by annual cost-of-living increases. It also seeks to set the minimum paid sick leave accumulate at a rate of one hour for every 30 hours worked; paid sick leave would extend to caring for family members.

The coalition behind the measure, Missourians for Healthy Families and Fair Wages, also turned in signatures from every county as a show of support. So far, they have at least 5,000 additional signatures deemed valid than required in six of the eight congressional districts.

“We’re not surprised to see these preliminary numbers from the Secretary of State because of the momentum on the ground we’ve felt for months,” Joni Wickham, communications director, Missourians for Healthy Families and Fair Wages, said in a statement. “ … We’re confident this initiative is headed for success on the November ballot.”

Signatures turned in by two other measures hoping to make the November ballot — legalized sports wagering and authorization to build a new casino Near Lake of the Ozarks — are still early in the process of being totalled by county election officials. 

In May, county officials were directed by the secretary of state’s office to verify signatures across the four campaigns in a particular order, with the abortion measure first, followed by minimum wage, sports wagering and finally, the casino, according to an email obtained by The Independent through a request under Missouri’s Sunshine Law.

This means counties are not nearly as far along verifying and totaling signatures for the two latter petitions. 

The sports wagering measure, which is run under a campaign called Winning for Missouri Education, would allow online platforms, major professional sports teams and the state’s licensed casinos to seek a sports wagering license. Net winnings would be taxed at 10%, and that revenue, estimated at up to $28.9 million annually, would support education programs.

“In the coming weeks we look forward to our official certification, which will allow Missourians to invest in our public schools by legalizing sports betting,” Jack Cardetti, spokesperson for Winning for Missouri Education, said in a statement.

The final measure, an effort to bring a new casino to the Lake of the Ozarks region, is headed by The Osage River Gaming & Convention committee. If approved for the ballot, and then by voters, it would authorize the development of a hotel, convention center, restaurants and other attractions. 

The proposal would also override a 2008 state law that currently limits Missouri to 13 licensed casinos.

“We turned in significantly more (signatures) than what was required,” John Hancock, a spokesperson for the committee, said Wednesday. “We are confident that we will have enough signatures once verified.”

Three of the four campaigns appear to have focused the bulk of their efforts on collecting signatures in all but the 6th and 8th districts, which make up northern and southeastern Missouri, respectively. 

Records obtained in May by the Independent indicating how many pages of signatures were turned in per county for each campaign, accompanied by the latest verified signature count, point to a renewed interest in Boone County following lawmakers’ decision to split it between the 3rd and 4th districts.

The minimum wage effort remains the outlier, with signature collectors appearing to favor the 6th district but skipping the 4th, which includes parts of Jackson and Boone counties.

The Independent’s Rudi Keller contributed.

Andrew Bailey is hoping to win his first full term as Missouri's attorney general after being appointed to the position in November 2022 by Gov. Mike Parson (Photo provided by Andrew Bailey's campaign).

Andrew Bailey was 16 years old and vice president of his high school Republican club when asked by a reporter if he supported the death penalty. 

“I do have a serious problem with the taking of a human life,” he told the Columbia Daily Tribune in 1997 for a story about the law, which remains on the books in Missouri. “But I can’t allow my emotions to fog my vision.” 

Years later, serving stateside after joining the Army following the Sept. 11 attacks, Bailey volunteered to take another man’s place and head oversees — the first of two deployments in Iraq. 

Those who know him best say Bailey has always been guided by morals shaped by a devoted faith and deep respect for the law. Now that he’s seeking a full term as Missouri’s attorney general — a job he was appointed to in 2022 by his former boss, Gov. Mike Parson — his friends say those values make Bailey an ideal leader whose sights are set on the welfare of Missourians rather than political aspirations.

“He doesn’t make personal evaluations based on emotions,” said James Lawson, his longtime friend and campaign manager. “Literally, every job this guy has ever had has been in the vein of public service.” 

His time as attorney general has been defined by confrontation — lawsuits against the federal government, investigations of health care providers and public fights with other statewide elected Republicans.

But it’s also been marked by accusations of corruption, incompetence and grandstanding, with his critics alleging he’s more interested in scoring appearances on Fox News than effectively running the sprawling office or winning in the courtroom.

The Republican hoping to unseat him in the Aug. 6 GOP primary — Will Scharf — says Bailey is part of a “viciously corrupt” political culture in Jefferson City.

Bailey deflected Scharf’s barbs as “baseless accusations,” adding that his steady stream of lawsuits have furthered Missourian’s health and safety.

“What I’ve learned is that you’ve got to be bold and have courage to make tough decisions when people’s lives are on the line,” Bailey said. “And that’s something I learned in the United States Army.”

To Bailey’s biggest supporters, it’s his aggressiveness advocating for the causes near and dear to his heart that is his biggest selling point to voters. 

“This is a guy who is an absolute warfighter,” Lawson said. “I mean, look at the way he runs the office. He’s aggressive, he’s bold. He takes action.

‘Proud to take an oath’

Lawson met Bailey as a teenager when they were both part of the Rock Bridge High School debate team in Columbia. They formed a friendship, Lawson said, over hunting, fishing and reading Western novels by Louis L’Amour.

Bailey spent part of his youth visiting family in Mississippi, where he regularly had the chance to watch his grandfather — the local sheriff — testify in court proceedings.

“I grew up thinking working with police to lock bad guys up was about the coolest job on Earth,” Bailey said. “And that’s really all I ever wanted to do.”

Bailey went on to attend the University of Missouri on an ROTC scholarship, then planned to go to law school and join the military as a judge advocate general. But his plans changed on Sept. 11, 2001. 

Lawson was with Bailey as they both watched the second plane crash into the Twin Towers.

“His countenance changed in a way that was different than the guy that I had known,” Lawson said of Bailey, who was 20 at the time. “I just knew that he held a deep responsibility to hold the parties responsible who were behind that attack.”

Bailey soon volunteered for the Army and was sent to Fort Knox, Kentucky, to train on tanks. 

He was assigned to a rear detachment, meaning he would stay in the United States while the rest of his unit deployed to Iraq. A friend with two prior deployments, a wife and children was about to be sent to Iraq a third time. 

Bailey, who was single at the time with no children, volunteered to take his place.

“Let me go,” Bailey recalls telling his superiors.

That’s how Bailey found himself living in a tent in the Nineveh Province of Iraq.

He rose in the ranks, eventually overseeing 200 troops and $100 million in equipment. By the time he left the Army in 2009 and headed to law school, Bailey had twice been deployed as part of Operation Iraqi Freedom. He said his second deployment lasted 455 days. 

He came home well-decorated. Bailey was honored in part for pulling soldiers out of a tank during an IED explosion, Lawson said.

A legacy of lawsuits

When Parson announced he was tapping his general counsel — who had no experience in elected office — to take over as attorney general, Jackson County Republican Chairman Mark Anthony Jones wrote a letter on behalf of his organization urging the governor to appoint anyone else.

“(Bailey) has little experience in the attorney general’s office, and what he has is from Democrat Chris Koster’s office,” Jones wrote. “He has only been an attorney for eight years. There MUST be other choices.”

Reached by phone last week, Jones said he has been “very surprised” by the job Bailey has done.  

“I love Andrew Bailey,” he said, before adding he’s not fond of Parson, but really likes Scharf. Jones added: “(Bailey) has been a fighter for Missouri. I cannot think of one thing that he’s actually done that I don’t like.”

Bailey has followed the lead of his predecessors and regularly sues the federal government. He’s twice sued to block federal student loan forgiveness, and in his most high profile case, carried forward a lawsuit alleging the Biden administration was censoring conservatives online by pressuring social media companies. 

“I wake up every morning and ask myself how I’m going to sue Joe Biden,” Bailey said during a May debate in Springfield.

His office is involved in four different lawsuits regarding medical records of transgender children — part of his effort to end gender-affirming care in Missouri. And Bailey has claimed credit for the closure of Washington University Transgender Center at St. Louis Children’s Hospital.

“How dare anyone tell these children that God put them in the wrong body,” Bailey told a crowd at the 2023 Family Research Council’s Pray Vote Stand Summit. “We know that he doesn’t make mistakes.”

He’s also joined a crowd of Republican attorneys general in litigation seeking to delay former President Donald Trump’s sentencing for 34 felony convictions, and sued the liberal watchdog Media Matters over its coverage of hate speech on the social media platform X. And he says $32 million in settlements and judgements have been awarded on behalf of defrauded Missourians through his office’s Consumer Protection Division.

But his proudest accomplishment, Bailey says, is his push to drive former St. Louis Circuit Attorney Kim Gardner out of office. 

“It’s something I’ll always look back on and be proud of the work that we did,” Bailey said. 

While Bailey has had his fair share of wins, he’s also suffered high-profile defeats. 

His social media lawsuit, which Bailey made a centerpiece of his legal assault on the Biden administration, was rejected by the U.S. Supreme Court, led by conservative Justice Amy Coney Barrett.

The state Supreme Court earlier this year ruled that lawmakers could not end Medicaid reimbursements to Planned Parenthood through the state budget. In its ruling, the court found Bailey’s office failed to appeal the claim that the budget decision infringed on equal protection rights, the Associated Press reported.

Among the many lawsuits Bailey inherited from his predecessor was a case against Missouri school districts that implemented mask mandates during the COVID-19 pandemic. After a judge ruled in support of the school boards, Bailey’s office missed its deadline to appeal.

Bailey has also faced criticism that he has mismanaged the office, resulting in missed deadlines and staff turnover — including from some of the highest profile lawyers in the office. 

“The result of that has been cases, including low level cases that should be handled easily by the office, being farmed out to private counsel,” Scharf said. “They’ve missed deadlines in numerous cases around the state. They’ve even been called to task for that by judges in any number of cases. It’s a real problem, the basic functioning of that office has been compromised by poor management.”

Bailey denies the accusations. 

“That’s nonsense,” Bailey said. “Whether or not a filing meets a deadline oftentimes is an issue that is litigated.” 

Bailey added that inherited an office with high turnover rates, but reduced it from 35% to 25% his first year in office.

Bailey also faced criticism — and a formal complaint with the Missouri Bar — after his office got facts wrong in a letter to the Hazelwood School District falsely blaming the school’s diversity, equity and inclusion program for an assault of a student off school property. 

Bailey said all facts his office cited in the letter came from media reports.

But the most pointed criticism is over campaign donations Bailey has accepted since he launched his run for a full term. 

Bailey recused himself from a gambling lawsuit filed against the Missouri State Highway Patrol after PACs connected to the lobbyist of the companies suing the state wrote checks to the committee supporting his campaign.

He raised eyebrows after accepting $50,000 in campaign donations from Doe Run, a St. Louis-based company being sued by thousands of Peruvians over allegations of lead smelter poisoning in their mining town in the Andes. A few months before the donation, Bailey filed a brief asking the federal court to move the lawsuit out of Missouri. 

“On issue after issue after issue,” Scharf said, “that office is compromised by special interests. And I think that’s just wrong.”

Bailey shrugs off Scharf’s criticism.

“We have substantially the same policy that’s been in place under the previous two administrations,” Bailey said. “And I’ll tell you, political donations don’t influence the decisions I make in my official capacity.”

A fight to end abortion

Abortion is a leading issue this election. And the fight against it has been a major focus of Bailey’s tenure.

He attempted to derail a constitutional amendment from reaching the November ballot rolling back Missouri’s abortion ban by trying to argue such a petition would cost the state trillions of dollars. The Missouri Supreme Court unanimously ruled Bailey had “an absolute absence of authority” to reject the state treasurer’s fiscal note.

Despite losing the case, Bailey’s efforts contributed to delays in the abortion rights coalition’s fundraising efforts.

He is currently suing a Planned Parenthood clinic near Kansas City over a secret video of a man pretending to have a pregnant, underage niece he wanted to take out of state for an abortion. Bailey alleges the video proves the organization is involved in “trafficking minors,” something Planned Parenthood vehemently denies. 

Bailey said his fight to end abortion is personal. 

In January 2017, Bailey’s daughter died the day she was born.

“We named her Grace because by the grace of God, I got to hold her for an hour,” Bailey said. 

At the first ultrasound, Grace was “provided a diagnosis that was inconsistent with life,” he said.

He and his wife choose to continue the pregnancy. 

“Look, I know that these are extremely personal conversations that people have, but I have faith that God designs every human being in the womb,” Bailey said. “And that we’re all made in His image. And I want all kids to have an opportunity at life.” 

Bailey believes Missouri’s current law, which prohibits abortion except in cases of medical emergencies when the mother’s life is at risk, “is the proper policy position to protect life.” 

After completing law school at the University of Missouri, Bailey worked as an assistant prosecutor in Warren County where Bailey said he was particularly moved by his interactions with victims. But his additional role as attorney for the county juvenile office – which Bailey said he took on to help make ends meet at home — changed his life. 

He watched children come in and out of the system. He said the number of children who didn’t have a home to go to on Christmas broke his heart. Eventually, he and his wife decided to foster and then adopt three of their four children, who now range in age from 2 to 11. He joked that they form “a soft Tampa to cover zone defense.”

Lawson said Bailey isn’t just a politician who talks about “life begins at conception.”

“Andrew is one of those people that has not only put his money where his mouth is on those topics,” he said, “he’s a guy that’s pulling kids out of the foster system.”

Lawson said the years spent watching Bailey fight for his family and community made the decision to join his best friend on the campaign trail an easy one. 

Until recently, Lawson worked in real estate. 

A “major” pay cut later, he reminisced on their high school debates when they took on complex topics and planned how they would change the world. Now, Lawson said, that dream is a reality.

“When you look at this election and this race, both of these attorneys are really smart people,” Lawson said. “But there’s a difference in terms of the bio and the legacy of service that these guys have … When we ask ourselves, who do we want to be the chief law enforcement officer in the state of Missouri? I want the guy that has run towards danger his entire life.”

Bailey said every morning of the school year, he drives his kids to the bus stop. He looks forward to the uninterrupted time spent hearing about their lives and thinking back to his own upbringing in middle America.

“It reminds me why I do this job,” Bailey said. “And reminds me that there are things worth fighting for.”

The Independent’s Jason Hancock contributed. 

Missouri Attorney General Andrew Bailey speaks to reporters after being sworn into office on Jan. 3. 2023 (photo courtesy of Missouri Governor's Office).

Missouri Attorney General Andrew Bailey does not believe it was improper to meet with a Jackson County official as his office sues the county, he told The Independent Thursday. 

Bailey’s comments came after a judge ordered him to sit for a deposition about the meeting, which may have violated legal ethics rules. In an interview, Bailey said his office was “weighing legal options to correct the mistake that we feel like the judge made in that case.”

“There’s nothing unethical for two Republican candidates for office to meet and talk about politics,” Bailey said.

Judge orders Missouri AG Andrew Bailey to sit for deposition over possible ethics breach

Clay County Circuit Court Judge Karen Krauser ruled Tuesday that Bailey could be questioned under oath as a form of sanction for meeting with Jackson County Legislator Sean Smith.  

The attorney general’s office is suing the county over its property assessment process, and the rules of professional conduct laid out by the Missouri Supreme Court prohibit attorneys from commuting about a lawsuit with individuals represented in the case without their lawyer’s consent. 

The judge has already determined that one of Bailey’s deputies violated the rules.

Asked if he would sit for the deposition, Bailey said he was “going to do whatever the law requires.”

“But we don’t think it’s proper for the court to essentially attach a form of liability for two Republican candidates for political office who have a campaign-related meeting,” Bailey said.

Krauser’s order stems from meetings Bailey and one of his deputies, Travis Wood, had with Smith this spring. 

Attorneys representing both the county  and the county legislature said in a motion for sanctions that Bailey’s office showed a “blatant disregard for the Rules of Professional Conduct” in meeting with Smith without their knowledge. They asked for several sanctions, including dismissal of the case, disqualification of Bailey from litigating the case or for permission to take Bailey’s deposition.

“Based on what is known today, it is clear the Attorney General’s Office has been working with Sean Smith on trial strategy against Jackson County,” the county’s filing said.

Krauser, who is handling the case after all of the Jackson County Circuit Court judges recused themselves, ruled on Tuesday that attorneys for the county could require Bailey to sit for a deposition. 

“The Missouri Attorney General’s Office is not exempt from the requirements of the state ethical rules, and this court finds that Travis Woods…violated the Rules of Professional Conduct,” wrote Krauser, who is handling the case after Jackson County judges recused themselves.

The attorney general’s office has been in litigation with the county since December when Bailey sued over Jackson County’s property assessment process. The lawsuit names as defendants Jackson County and its legislature; County Executive Frank White Jr.; director of assessment Gail McCann Beatty; the Jackson County Board of Equalization; and Tyler Technologies, a software company hired by the county. 

The lawsuit claims the county violated the law when it assessed property values last year resulting in an average 30% increase in value across hundreds of thousands of properties. The lawsuit says more than 90% of residential properties saw their values increase, and values increased by at least 15% for three-quarters of properties.

The increase in property values means some owners will have to pay more each year in taxes. 

The attorney general claims Jackson County failed to notify owners of the property value increases and their right to a physical inspection — which is required before the assessor can increase a home’s value by more than 15% — in a timely manner. The county didn’t conduct all the required inspections before hiking values more than 15%, the lawsuit says. 

Jackson County has denied the accusations and accused Bailey of waiting too long to file the case since tax bills have already been paid and money distributed. Beyond that, the county argues, the attorney general can’t file a case unless the State Tax Commission has attempted to resolve the issue first.

Requiring the state’s top lawyer to sit for a deposition is exceedingly rare, according to legal experts. And the admonishment from the judge drew criticism from rivals vying for Bailey’s job.

“It is absolutely outrageous that this important litigation against Jackson County is now imperiled because Andrew Bailey wanted a quick hit for his campaign,” said Will Scharf, who is running in the Republican primary for attorney general against Bailey.

Bailey’s campaign responded with a statement criticizing Scharf for working in the scandal-plagued administration of former Gov. Eric Greitens and accused Jackson County of misleading the judge.

Elad Gross, who is running for attorney general as a Democrat, said on social media “we need to fire our corrupt attorney general.”

“Attorney General Andrew Bailey repeatedly violates Missouri ethics rules,” Gross said. “He takes money from opponents. He makes up facts. He sells out the people of Missouri for campaign cash and uses taxpayer resources to support his campaign.”

This story was updated at 2:55 p.m. to include a statement from Bailey’s campaign and correct a misspelling.

A series of changes to Missouri's child care subsidy program have created a major headache for day care providers, who say they've been forced to make difficult budget decisions as they wait on money owed to them by the state (Rebecca Rivas/Missouri Independent).

This spring, the state of Missouri owed Kimberly Luong Nichols $5,000 in backlogged payments for children at her Kansas City daycare who were part of a state subsidy program.

For four years, she’s operated a licensed daycare inside her home, where she currently serves 10 children. Luong Nichols stopped drawing a salary last summer to pay for improvements to her center and two new hires, expecting to draw down a salary again this year. 

When the full subsidy she was owed stopped arriving, she laid off those staff.

And as they’ve done for the past year, her family of six relies solely on her husband’s $53,000 salary. 

They’ve given up little luxuries like going out to dinner and buying fancier shampoo. And they’ve given up bigger luxuries, like vacations. 

When bill collectors started calling, her husband considered getting a second job. On several occasions, she considered doing away with the daycare entirely. But she didn’t, not wanting to leave the families — many of whom have children with developmental disabilities, or who are in the foster care system — with the stress of searching for a new day care. 

Luong Nichols is among thousands of child care providers across Missouri who rely on a state child care subsidy program to keep their daycares afloat.

The subsidy, part of a federal block grant program that is state-administered, helps cover the cost of serving low-income and foster children. 

But since late last year, a series of changes created a major headache for many providers and families, as parents were unable to register their children and providers in the most dire circumstances were left without money to pay their staff.

The Missouri Department of Elementary and Secondary Education, which oversees the program, has largely blamed a contracted vendor for the months-long backlogs. The system, which launched in December, is still not fully operational. 

“ … There have been a number of unforeseen challenges during the transition, which involves loading family and provider data from the existing state systems into the new (Child Care Data System),” Mallory McGowin, a spokesperson with the department of education said in a statement Wednesday. “The (Office of Childhood) is working hard to mitigate these issues and sincerely apologizes to the child care providers and families affected.”

But similar backlogs plagued the system three years ago, as parents struggled to enroll children and providers had to make serious budget cuts.

The latest problems have forced some daycares to close. Others have shifted from serving vulnerable children who qualify for the state subsidy to only admitting families who can afford to pay on their own. 

Many providers, like Luong Nichols, have weeks where they’re barely hanging on.  

Payment backlogs not new

In Missouri, child care providers can be registered to get a government stipend for every child on subsidy, meaning they receive a partial amount of tuition directly from families, and then the government covers the rest after care has been provided.  

The child care subsidy is a federal program administered by states through the Child Care and Development Block Grant. Families apply for the state to directly pay a child care provider for part of the cost of care.  

Only very low-income families qualify in Missouri, along with foster kids and children with special needs. The maximum income a family can make to qualify is 150% of the federal poverty line, or $46,800 for a family of four.

The average cost of full-time, center-based care for an infant in Missouri was $11,059 as of 2022, according to Child Care Aware. 

There were about 21,000 children receiving the state subsidy as of November, the last publicly available state data. The program shifted from being administered by Missouri’s Department of Social Services to the education department in December. McGowin said the current number is closer to 23,000 children.

Roughly 1,800 of Missouri’s 2,800 licensed and license-exempt providers, including school districts, are contracted to take children on subsidy, Pam Thomas, assistant commissioner for Missouri’s Office of Childhood, said at a State Board of Education meeting last month. 

“We do continue to struggle a bit with our vendor and meeting what our expectations are for an efficient and effective system and making clear what’s needed,” Thomas told the board. “And quite frankly the vendor is not delivering on those results to what I would say are our expectations as a department.” 

The vendor contracted to develop and implement the new system for the subsidy program is World Wide Technology, McGowin said, a large technology services provider headquartered in St. Louis.

Board members expressed concerns with how to move forward as Thomas reassured them that her department was working “around the clock” to urge the vendor to fix the bugs in the system, which spans about nine steps between a family’s application for subsidy and payment to the provider.

“We have to be cautious about how many more changes we add into the system right now,” she said. “ … We can bend it, but we certainly can’t break it, and I think we’re on the verge of that right now.”

Yet this isn’t the first time the state’s handling of the subsidy program has caused widespread problems for providers and families. 

Emails show months-long backlog of payments to Missouri child care providers

In 2021, the state blamed the COVID-19 pandemic and the rollout of a new system used to track attendance, called KinderConnect, for a backlog of thousands of payments. 

In spring 2023, parents reported waiting several months to be approved for the state assistance, leaving them struggling to juggle work and child care. 

State Sen. Lauren Arthur, a Democrat from Kansas City, said she was notified of the current spate of issues a few months ago by legislative staff who’d started hearing concerns from constituents. 

“It feels like way too much time has passed,” Arthur said. “I suspect that child care providers across the state have already closed as a result of these mistakes and it’s totally unacceptable when already providers are struggling. There are already not enough seats available for children who need them.”

Asked last month if she was looking at alternative vendors ahead of the current multi-million dollar contract running out in December, Thomas, with the education department, said she wasn’t opposed. 

However, on Wednesday, McGowin, said the department is not currently planning on finding a new vendor. The subsidy payment issues – 60% of which came from technical issues, according to the state – are expected to be resolved by the end of July. 

Missouri pays providers for services after they’re performed, rather than in advance. This, coupled with the fact that providers are paid based on attendance rather than enrollment for children in the subsidy program, makes budgeting nearly impossible for providers who take low-income and foster children.

“We’re really relying on the state and DESE to really prioritize solving these system challenges so providers can be paid quickly,” said Casey Hanson, director of outreach and engagement at the child advocacy nonprofit Kids Win Missouri. 

Hanson has spent hundreds of hours with child care providers over the past several years. She knows what’s at stake.

“They’re some of the most resilient people,” she said. “They care about children, they care about the future of our state more than almost anyone.”

‘Our own personal pandemic’

Tina Mosley was among the providers who made the difficult decision to stop taking children on subsidy. 

For 28 years, she has owned and operated Our Daycare and Learning Center in St. Louis, which is licensed for 10 children. It sits in the Normandy school district where the median household income is less than $39,000, and more than 56% of students in public school have SNAP benefits, according to 2021 data from the National Center for Education Statistics.

Every other provider she knows in the area accepts children on subsidy. And they’re all in the same predicament.

“Every one of my colleagues and friends, the state is behind on paying them,” Mosley said. “To the right of me, to the left of me, across the street from me, behind me.”

By only taking private paying families, and by ceasing to collect a salary, Mosley said she’s been able to continue employing her two staff, both of whom are young mothers. And while they no longer take children on subsidy, they still service lower income families, she said. 

As a result, she’s not left waiting on payments from the state. A handful of home and center-based providers she knows in the St. Louis area already closed because of the lag.

Several months ago, when most of her children were from the subsidy program, she was helping parents sign up for state benefits as the system transitioned over. She recalls parents sharing screenshots of hold times on the phone with the state surpassing an hour before they had to hang up and return to work, unable to get the immediate help they needed.

“Early child care right now, we feel like we’re in our own personal pandemic,” Mosley said. 

But unlike during the COVID-19 pandemic, when government bodies and communities showed up in stride to keep child care providers in business, Mosley said it feels like most people have now turned their backs.

Luong Nichols, in Kansas City, has considered doing what Mosley has done: stop opening her services to families on subsidy.

In an April email to a staffer in Arthur’s office, she lamented her situation. The system had two of her kids on subsidy listed as private pay. A glitch wouldn’t let her submit attendance. She hadn’t heard back on her help ticket. 

“I am due to renew child care subsidy next month and really considering not doing it,” she wrote in an email she shared with The Independent. “Payments are still not correct, they owe me all of February and past corrections. Now we are about to end March and that will be added.”

After sending this email, Luong Nichols went on to interview at a local school district. She ultimately turned down the job offer, unable to part with the children in her care, including foster children, kids with behavioral difficulties and low-income children.

“I have single moms and foster children that have been kicked out of other daycares or gone through many placements before they landed on my door. And the kids that I take care of, they’re like family.”

Instead she continued to spend hours on the phone during nap time begging anyone to make her business whole again. She called the Missouri Department of Elementary and Secondary Education and the governor’s office. She even called the White House. 

“I’ve had to take on an extra load of work just to fight for something that I’m entitled to,” she said. 

As of Wednesday, she said her payments were caught up through May. She credited her persistence, and assistance from Arthur’s staff, for speeding up the payment.

At the same time, Luong Nichols has seen three area centers and four private daycares shutter. She directs most of the blame at the department of education.

“DESE has pushed the industry to the point of no return right now,” she said. ”We’re not going to have enough child care providers in the state of Missouri by the end of this year to take care of subsidy children.” She said it will move to private paying families only. 

Hanson, with Kids Win Missouri, said there isn’t currently enough data to know the reality of the child care landscape. 

In response to a Sunshine request submitted by The Independent last month, the education agency said they do not currently track the number of backlogged payment resolution requests. 

“The reality is, yeah, there are providers that will close,” Hanson said. “That’s why we continue to advocate that we need more state level funding in this space to really maintain a supply.”

The message "You are not alone, support is here" is painted on the window of the Planned Parenthood Great Plains on Friday in Overland Park, Kansas (Anna Spoerre/Missouri Independent).

When Missouri outlawed abortion two years ago, Nicole was far more worried for her grown children than for herself. 

It had been two decades since she last gave birth, when she suffered a serious stroke during labor followed by severe postpartum depression. She was outraged that the U.S. Supreme Court overturned the constitutional right to abortion, but pregnancy was in Nicole’s past.

That changed a couple weeks later, when her IUD failed. 

“Are you kidding me?” she recalls thinking, looking around at the life she and her husband had built together in southwest Missouri.

In her 40s and living in a state where virtually every abortion is now banned, Nicole — who asked to only be identified by her middle name for fear of prosecution — was among the first of thousands of Missouri women forced to navigate abortion access in a post-Roe world. 

On June 24, 2022, Missouri became the first state in the country to respond to the U.S. Supreme Court’s landmark ruling in Dobbs v. Jackson Women’s Health, striking down Roe v. Wade and the constitutional right to an abortion. The Republican-run state quickly enacted its trigger law banning all abortions with limited exceptions in cases of medical emergencies.

In the two years since, countless women like Nicole have faced already tough decisions made more excruciating by having to find discreet ways to manage their own health or travel far from home for care.  

Missouri already had some of the strictest abortion regulations in the country, pushing most women seeking access to the procedure out of state. But the end of Roe raised the stakes, leaving women in Missouri — which already has some of the highest maternal mortality rates in the country — fearful that in the most extreme cases, the ban could mean their death. 

Last year, approximately 2,860 Missourians traveled to Kansas last year for abortions, and 8,710 traveled to Illinois, according to the Guttmacher Institute, a reproductive rights research group that closely tracks abortion data. But they made up only about 10% of the total abortion patients in each state.

After Dobbs, Missourians’ access to care in states like Kansas and Illinois became precarious as abortion bans became more widespread.

“In a matter of months, we started serving patients from Texas and Arkansas and Oklahoma,” Emily Wales, CEO and president of Planned Parenthood Great Plains, said of the time immediately following the Dobbs decision. “Missourians had to really compete for too few appointments.”

The longer wait times at clinics and barriers to traveling for abortions has led Missourians to increasingly consider self-managed abortions.

That includes Nicole, who received an envelope at home marked with international postage containing Mifepristone and Misoprostol after consulting an online doctor she found through Plan C, a nonprofit that helps people find providers.

Missourians navigate abortion access after Dobbs

For Nicole, the decision to end her most recent pregnancy was simple. To continue felt unsafe, she said, and she and her husband didn’t want to start over raising a child. 

But the conversations that followed were kept strictly between the husband and wife. 

With pervasive uncertainty around whether or not women could be prosecuted for self-administering medication abortions in Missouri, the stakes are higher than ever for those trying to end unwanted or medically complicated pregnancies. 

It’s why Nicole didn’t tell her pastor at church. She didn’t tell friends or family. Nicole didn’t even tell her gynecologist, fearing she would be reported by someone in their corner of the state where anti-abortion messaging proliferates billboards, bumper stickers and handwritten signs staked into yards.

Ultimately, Nicole couldn’t imagine fleeing her state for the procedure. She wanted to be home. 

“I felt really angry that I would have to leave my community,” she said. “It’s not a shameful thing, it’s a procedure. It’s a medical health care procedure.”

Emergency care for pregnant women at stake in Supreme Court case, Missouri doctor warns

In the six months after the Dobbs decision, the number of self-managed medication abortions rose by more than 26,000 across the U.S. according to a study published in JAMA, the American Medical Association’s journal.

While medication abortions are overall very safe, effective and approved by the FDA to end pregnancies up to 10 weeks, there is some risk associated with any medication. Self-managing an abortion alone, without a local medical provider’s guidance, can be nerve-wracking.

In the unlikely situation that Nicole started hemorrhaging, she and her husband mapped out the closest Kansas hospital that would have the level of care they needed. 

When the time came, they both took a day off work and snuggled on the couch. Nicole pressed a heating pad to her abdomen to soothe the cramps, which she described as similar to period pains. Then came the relief.

After the abortion, her husband got a vasectomy. She kept the IUD. Despite their precautions, sex is now accompanied by paranoia as Nicole counts down the days to her period each month. 

She ordered extra abortion medication in case anyone she knows might need it. And despite the nearly two years since her abortion, Nicole said she still can’t shake the absurdity she felt hunkering down in her home that day.

“I make decisions for myself every day, and I make good decisions,” she said. “The audacity that people think I can’t make the best healthcare decisions for myself — it’s hard for me to put into words how upsetting it is.”

‘I am desperate’

Stories of women desperate to end their pregnancies proliferate the internet. 

Reddit is increasingly a gathering place for those seeking answers and assurance. Many of the posts — all anonymous — illustrate how terrified many Missourians are. 

In one post from mid-June, a 23-year-old woman from Missouri feared she was pregnant by her abusive boyfriend but didn’t have the money to travel for an abortion.

“I will drink an entire bottle of vodka if I have to idc,” she wrote. Other anonymous users quickly took to the page to offer other solutions.

In a 2023 post, someone inquired about getting an abortion for their pregnant 15-year-old sister in Missouri without parental consent. 

“This experience is causing her to have suicidal thoughts, crippling anxiety, and extreme depression,” the user wrote. “All of which she already had before this. I need help. I am desperate. I do not want to lose my baby sister.”

Even for those who work in abortion-rights advocacy, navigating an abortion post-Roe is anxiety-inducing.

Maggie Olivia first got pregnant while living in St. Louis in 2020. She was on birth control at the time. 

Because of Missouri’s “targeted regulation of abortion providers” laws, including mandatory pelvic exams for medication abortions and 72-hour waiting period between the initial appointment and a surgical abortion, she was encouraged to go to a Planned Parenthood in Illinois.

It was clinic escorts with Abortion Action Missouri who guided Olivia into her appointment just across the Mississippi River and reassured her ahead of the procedure. She was so moved by their kindness that Olivia went on to volunteer with the group, and now serves as a senior policy manager with the abortion-rights group.

In the months after the Dobbs decision, Olivia, like many in abortion advocacy work, was navigating the ever-changing landscape of abortion access. At the same time, Olivia said she was mistakenly denied her birth control prescription by a pharmacist after switching contraceptive methods. 

When a pregnancy test came back positive several weeks later, Olivia’s first call was to her boss, who she said offered immediate support and guidance. 

“But even that close proximity to the reality of the crisis doesn’t make being pregnant when you don’t want to be any less horrifying,” she said. 

Unlike with her first pregnancy, Olivia decided not to tell her health care providers in Missouri.  

But after ending up in the emergency room for unrelated reasons, her pregnancy was noted in her records. Months later, Olivia said she was denied access to an unrelated medication because her medical records said she was pregnant, compounding the fear she already had of being punished in some way for having an abortion, however legal, in Illinois.

“It was very upsetting,” Olivia said. “And I had thought that I had taken steps to be precautious.”

When she had her second abortion at the same Illinois clinic from two years prior, she also had an IUD placed.

“Your access to abortion doesn’t need to be attached to some traumatic, horrifying situation in of itself,” Olivia said. “Being pregnant when you don’t want to be is scary enough, is horrifying enough.”

Higher stakes for providers

When a sonographer approaches Dr. Jennifer Smith, a St. Louis OB-GYN, her heart drops.

“Every time I look at a fetal ultrasound, it takes on new intensity and new anxiety,” she said, concerned that her patient will have a diagnosis they can’t be of help with in Missouri. 

Missouri physicians are balancing medically complex pregnant patients with legal restrictions that could land them in prison for up to 15 years if they perform an abortion the state finds was unnecessary, and, therefore, illegal. 

No providers have been prosecuted at this point, but the ways something could go wrong keep Smith up at night. So, too, does the future of not only maternal health care, but also motherhood in Missouri.

“Missouri women are afraid to be pregnant in Missouri,” Smith said. “They are so worried that they might die while pregnant, or that they may get pregnant with a baby with anomalies and have no options because they live in Missouri.”

While Smith is often helping women who want to be pregnant, a couple miles across the river in Illinois sits the regional logistics center for Planned Parenthood of the St. Louis Region and Southwest Missouri. There, three patient navigators help those trying to end their pregnancies. 

Kenicia Page, the call center manager, said she saw a tremendous increase in callers from the West Palm Beach area, more than 1,100 miles south, when Florida’s ban went into place on May 1.

Right now, she says the clinic receives about 100 calls a day.  

They act as pseudo travel planners and financial aid counselors, helping book transportation and finding funding for patients. 

Despite the comparative proximity, transportation can still be a headache for some Missourians, particularly those in rural parts of the state without access to public transportation like Greyhound buses or Amtrak, Page said. Sometimes, when the patient doesn’t have a vehicle, nor access to public transportation or car rental services, their next best option is to rent a U-Haul to drive to their appointment.

But more often, Page said, she hears from Missourians trying to find and afford child care, or from minors who need a legal guardian to give consent for financial assistance. Some days Page still finds herself breaking the news to Missouri callers that abortion is illegal within their state borders, and that they will likely have to take a multi-day trip to Illinois to get care.

Page recently spoke with a woman who was homeless and living in a hotel with her children. She had no child-care options, nor a place to stay after the procedure. Page’s team helped connect the woman to funders who assisted with the day care fees and made sure she had a safe place to recover overnight in Illinois. 

Their work is done when they get the final call or text from a patient saying they’ve returned home safely. 

“It gives you that extra energy or extra push, determination, to continue to do what you do,” Page said. “Because it is definitely making a difference.”

Alison Dreith’s hotline through Midwest Access Coalition, an abortion fund based in Illinois, used to serve a majority of Missouri clients. As of mid-June, only 26 of the total 1,052 callers this year were from Missouri. Now most of her calls come from Texas, Indiana and Tennessee as patients from red states crowd clinics in Illinois and Kansas. 

“Every time a new state goes,” Dreith said, “it has the ripple effect that reaches the Midwest.”

The need for child care is a refrain for patients, particularly lower-income Missourians,traveling to Kansas overnight for the procedure, said Wales, with Planned Parenthood Great Plains.

The short drive from Kansas City to Wyandotte or Johnson counties in Kansas has expanded from a fissure to a canyon for some patients. Those requesting medication abortions are usually seen within a week, but patients needing in-clinic abortions can wait two or three weeks to be seen, Wales said.

“We have to explain that we may be close to you, but we are seeing patients from around the region,” she said. “It doesn’t make it easier, necessarily, to get an appointment.”

Wales said many patients are also coming to them later in gestational age, and increasingly with fetal abnormalities. This is a theme across the country, as patients work to find an appointment, save up money and arrange time off work.

Because of the increase in demand, Planned Parenthood Great Plains will soon start seeing patients for abortions in Pittsburg, making it the fourth Kansas clinic to offer the procedure. She hopes that will cut down on drive times for Missourians in regions including Joplin and Springfield.

Julie Burkhart, co-owner of Hope Clinic, an abortion provider in Granite City, Illinois, has seen the number of Missourians served at her clinic more than triple since 2019. But even so, the percentage of total patients from Missouri has gone from more than 60% to less than half as patients from 28 states made their way to her clinic near the Mississippi River last year.

Wait times hover between one and two weeks. In May, the clinic saw 732 abortion patients; 45 were from Missouri. 

Funding needs have skyrocketed since Roe fell, and she’s seen the number of Missouri patients seeking abortions in their second trimester increase to 17% this year. Before Roe, it was closer to 8% for all patients.

“With Roe falling, people who don’t have to think about abortion access every day don’t quite know where to look, who to call, who to talk to,” Burkhart said. “It’s put people in more desperate situations.”

This story was corrected at 4:45 p.m. to accurately describe the nonprofit Plan C. 

A judge declined to dismiss a lawsuit filed by Attorney General Andrew Bailey against Planned Parenthood Great Plains based on a Project Veritas video (Photo by Michael Thomas/Getty Images).

A lawsuit filed by Missouri Attorney General Andrew Bailey accusing Planned Parenthood of transporting minors out of state for abortions will move forward, a judge ruled Tuesday evening.

The lawsuit is based on conversations between Planned Parenthood staff and a man with Project Veritas who secretly filmed the staff while inquiring about an abortion for his fake 13-year-old niece. 

Planned Parenthood Great Plains, which runs the Kansas City area clinic where the video was taken, asked that the judge dismiss the lawsuit shortly after it was filed. 

“We’re reviewing all our options and will continue to vigorously defend this case based on hypotheticals and fictitious patients,” Erin Thompson, general counsel with Planned Parenthood Great Plain, said in a statement Wednesday.

At a hearing in early June, John Andrew Hirth, an attorney for Planned Parenthood, said there was no proof the Kansas City area clinic broke the law.

“There’s no allegation that any abortion has been performed either in Missouri or outside of Missouri, with or without parental consent here,” Hirth said. “The whole conversation is hypothetical.”

But Boone County Judge Brouck Jacobs found merit for moving forward with the case. He did not issue an opinion along with his ruling explaining his reasoning.

“This is the beginning of the end for Planned Parenthood in the State of Missouri,” Bailey said in a statement Tuesday following the ruling.

Missouri Planned Parenthood clinics remain ‘open to all’ despite new Medicaid restrictions

The video, captured in December, was posted on social media by Project Veritas, a self-proclaimed right wing news organization that often conducts undercover stings. 

The man filming in the clinic told staff that the made-up girl’s parents couldn’t know about the abortion. Staff then directed him to their affiliate clinics in Kansas where they said he could “bypass” parental consent.  When the man asked how often girls go out of state for abortions, the Planned Parenthood employee said it happens “every day.”

Kathryn Monroe, who represented the attorney general’s office at the hearing, said while the man’s questions were hypothetical, the employee at Planned Parenthood thought the situation was real. 

“There was admitted conduct about what they would do in this actual situation,” she said.

The attorney general’s office in its arguments before the court pointed to Missouri law which states: “No one shall intentionally cause aid or assist a minor to obtain an abortion.” 

That law was written before the state’s trigger law went into place in June 2022, effectively making all abortions — with the exception of life-threatening situations — illegal.

Missouri doesn’t have explicit laws requiring parental consent for minors getting abortions in other states, nor does it prohibit minors from going to other states to get abortions.

Kansas law requires physicians to either obtain parental consent or to go through the judicial bypass process where a judge can authorize a minor to get an abortion without parental consent.

A spokesperson for Planned Parenthood Great Plains said in February that they do not provide any form of transportation directly to any patients, regardless of age or where they live.

Jennifer Smith, an OBGYN, speaks about medical challenges without legal abortions in Missouri during a rally held by Missourians for Constitutional Freedom Friday morning (Annelise Hanshaw/Missouri Independent).

When a woman experiencing a second trimester miscarriage came into the hospital bleeding through her clothes, Dr. Jennifer Smith couldn’t immediately help her. 

Not while her fetus still had a heartbeat.

Too scared to wait for the miscarriage to progress far enough to be admitted to the hospital in Missouri, the woman and her husband drove to Illinois where she could obtain an abortion. 

Until the situation is life-threatening to the mother, her hands are tied, said Smith, an OB-GYN in St. Louis. But at least in the worst emergency cases, Smith knows she can help thanks to a federal law called Emergency Medical Treatment and Active Labor Act (EMTALA).

“It’s just hard to imagine that we’re living in a time where that actually may not be true,” Smith said. 

The U.S. Supreme Court will soon decide whether a federal law mandating hospitals treat and stabilize every patient, regardless of their ability to pay, includes providing abortions where they are otherwise illegal.

In the case, the Biden administration sued Idaho to block enforcement of its abortion ban, arguing that it violated EMTALA by denying women abortions in emergency situations. Idaho bans abortions in almost all cases, with exceptions to save the life of the pregnant woman or when the pregnancy is the result of rape or incest. 

In response, Idaho argued that the federal law only requires “stabilizing treatment for the unborn children of pregnant women.” Idaho is asking the court to lift a temporary injunction blocking enforcement of its abortion ban in hospital emergency rooms.

The government is arguing that EMTALA requires hospitals to provide abortions needed to stabilize or save the life of a pregnant patient It also protects doctors from prosecution.

Without the law, hospitals and health care workers would have to wait until a mother is actually dying to proceed with a life-saving abortion, Smith said. St. Louis area hospitals still perform abortions for ectopic pregnancies, a nonviable pregnancy that if left unaddressed can be life-threatening to the mother, Smith said. But without EMTALA, she’s not so sure.

“It leaves every person involved in the care open to be prosecuted,” Smith said.

After Missouri banned abortion, the state saw 25% drop in OB-GYN residency applicants

In May, nearly 6,000 physicians across the country signed a letter on behalf of the Committee to Protect Health Care asking the Supreme Court to uphold the federal law. 

Smith was among 32 Missouri doctors to sign on.

In June 2022, Missouri became the first state to ban abortion following the Supreme Court case overturning the landmark Roe v. Wade decision. The ban was triggered under a law passed in 2019 that made it effective with the Supreme Court action.

The 2019 law states abortions will only be permitted in cases of a medical emergency when “a delay will create a serious risk of substantial and irreversible physical impairment of a major bodily function.”

Health care providers who perform abortions not necessary to save the woman’s life can be charged with a class B felony. If convicted, they would face up to 15 years in prison and their medical license could also be suspended or revoked. 

Because of this ban, some doctors and hospitals in Idaho recently stopped admitting pregnant patients who came into the emergency room, potentially needing abortions to save their lives. Instead, women are being transferred to other states for treatment during emergency situations. 

Since Roe was overturned, a Missouri hospital became one of the first in the nation to be cited for violating EMTALA by denying a pregnant woman emergency care. 

In August 2022, Mylissa Farmer entered a Joplin emergency room after her water broke at about 18 weeks pregnant. Even though the pregnancy was no longer viable, because the fetus had a heartbeat, and because Farmer’s condition wasn’t immediately life-threatening, she was turned away. She returned the next day, was kept overnight and then released without additional treatment.

Freeman Health in Joplin was later cited for being in violation of federal law. 

“Although her doctors advised her that her condition could rapidly deteriorate, they also advised that they could not provide her with the care that would prevent infection, hemorrhage, and potentially death because, they said, the hospital policies prohibited treatment that could be considered an abortion,” the report from the U.S. Secretary of Health and Human Services stated. “This was a violation of the EMTALA protections that were designed to protect patients like her.”

Smith said that while she and her colleagues often aren’t able to immediately help patients who experience situations like Farmer, she can at least direct them to care a short drive away in Illinois. 

Prior to the Dobbs decision that overturned Roe, Smith said if a pregnant patient experienced premature rupture of the membranes, they could deliver the baby so the family could have some memories to hold on to. 

Often parents would get copies of their child’s footprints and say their goodbyes.

Now, since they can’t act while the fetus has a heartbeat, Smith said she refers patients to abortion clinics in Illinois where they can receive a surgical abortion. But as a result, they don’t get to hold their baby, and often have to navigate anti-abortion protesters on the way. 

To Smith, it’s not worth risking the mother’s life and well-being to wait for her condition to deteriorate. 

“To delay the care of the mother based on the beating heart of the baby is so counterproductive,” she said. “ … It just takes one emergency that we don’t act on or that we delay to change the life of a whole community.”

A decision in favor of Idaho could impair care for pregnant patients with serious injuries from car accidents or gunshots, or who suffer a stroke, Smith said. In those cases,  saving the mother sometimes isn’t possible without first delivering the pregnancy, whether viable or not. 

Pregnant women can quickly lose blood in emergency situations, potentially putting the mother and child’s lives at risk, she said. 

“Unless you’re a trauma physician, it’s an amount of blood that nobody else in the hospital deals with. It’s an unbelievable amount and it can happen so fast,” she said. “If you have to wait and question your legal standing, the likelihood of saving that patient intact, saving the baby, saving her uterus, all of it, it just goes down all the time.”

The Supreme Court could rule on the EMTALA case as early as next week. Until then, doctors continue holding their breath. 

“They’re just singling out pregnancy at this point,” Smith said. “But once you start chipping away at rights, it’s really unclear where the end point is.”

Students hold up anti-abortion signs at the Midwest March for Life on May 1 at the Missouri State Capitol (Anna Spoerre/Missouri Independent).

Missouri’s near-total abortion ban does not fly in the face of the state constitution’s separation of church and state, a St. Louis judge determined. 

The ruling came Friday, several days shy of the 2-year anniversary of the U.S. Supreme Court decision that struck down the constitutional right to an abortion and paved the way for Missouri to become the first state to ban the procedure. 

Last year, 14 Missouri clergy members across seven denominations sued the state, alleging the ban violated Missouri’s strict separation of church and state. They demanded that the abortion ban be lifted. 

The clergy members in their initial complaint took issue with state law which says “life begins at conception,” arguing that lawmakers “weaponized their religious beliefs” in a way that not every religion or religious person agrees with. 

But in a 44-page ruling that delved into the state’s abortion restrictions dating back to 1825, St. Louis Circuit Judge Jason Sengheiser decided the state had not erred and dismissed the lawsuit.

“While the determination that life begins at conception may run counter to some religious beliefs,” he wrote, “it is not itself necessarily a religious belief.”

The ruling

In 2019, while debating what would become the state’s “trigger law,” many Missouri lawmakers called on their faith as their guide in supporting the legislation. 

That included then-state Rep. Nick Schroer, who co-sponsored the legislation dubbed the “Missouri Stands for the Unborn Act.” Schroer, who is now a state senator, said at the time that his Catholic faith instructed his decision to file the bill.

His bill ultimately passed, making it possible for Missouri to outlaw abortion in June 2022, when laws around abortion were returned to state leaders’ hands. Now in Missouri, abortions are only legal in emergency situations “to avert the death of the pregnant woman or for which a delay will create a serious risk of substantial and irreversible physical impairment of a major bodily function of the pregnant woman.”

Health care providers who perform abortions not necessary to save the woman’s life can be charged with a class B felony, which means up to 15 years in prison. Their medical license can also be suspended or revoked as a result.  

‘No protection’: Missouri advocates sound alarm after IVF safeguards stymied in legislature

“By legislating that life begins at ‘conception,’ the Missouri legislature dictates a narrowly Christian perspective onto all of Missouri’s diverse faith communities,” the lawsuit reads. 

The clergy members pointed to a different part of the state constitution when making their argument. Specifically a section that reads: “The state shall not coerce any person to participate in any prayer or other religious activity.”

Sengheiser disagreed with their assertion that the “trigger law” is unconstitutional on these merits.

“The intent of the Missouri legislature has become increasingly couched in religious language,” the judge wrote. But he added that lawmakers have also made “extremely detailed medical and scientific findings” in state law based on increased knowledge of fetal development. 

Clergy members share abortion stories

At least three clergy members who filed the suit have previously had abortions. 

Among them is the Rev. Cynthia Bumb, of the United Church of Christ in St. Louis, who had a surgical abortion in 1993 in Missouri at 12 weeks pregnant after she learned the fetus was nonviable. 

And Rabbi Susan Talve, of Central Reform Congregation of St. Louis, who had an abortion in 1973 in New York City when she was 19, a choice she wrote she was “immensely relieved” to have. 

The lawsuit also included the story of the Rev. Barbara Phifer, a United Methodist minister in St. Louis County, in which she told her own story of needing an abortion in Missouri in 1978. 

She wrote that while she was in seminary, she experienced a miscarriage in which the fetus didn’t pass naturally. Phiger said it took her five weeks to be admitted into a Missouri hospital to receive a surgical abortion, during which time she said she could have died.

Now a Democratic state representative and candidate for secretary of state, Phifer said she often counsels families who ask her advice on whether to have an abortion. She said she encourages them to consider factors such as their finances, emotional resources and health. 

Phifer in the suit wrote that she believes current state laws “remove the decision-making capacity from pregnant people, which conflicts with her belief that all people are made in God’s image as autonomous beings with equal capacity to direct their lives.”

No ruling on TRAP laws

The lawsuit also asked the court to dismantle a series of TRAP laws put into place in the years leading up to the state’s near-total abortion ban. These “targeted regulation of abortion providers” laws impaired abortion access across the state until only one abortion clinic remained in Missouri by 2019.

The clergy members argued the following TRAP laws were also in violation of the separation of church and state: A mandatory 72 hour waiting period between an appointment to inquire about an abortion and the actual procedure, which must be done by the same physician seen initially and a state-mandated pamphlet given to patients that states abortions “terminate the life of a separate, unique, living human being.”

Sengheiser ruled the argument against TRAP laws was no longer ripe, since the abortion ban essentially negated the need for any of those laws to be enforced. 

The clergy members in a statement Friday said they are considering whether to appeal.

Danielle Faith Zoll's daughter, Makayla, who is now 2 years old, was the result of her sixth embryo transfer. Zoll, 37, of St. Louis, now runs a nonprofit called Making a Miracle which offers support to other families struggling with infertility (Photo provided by Danielle Faith Zoll).

Danielle Faith Zoll and her husband have one last embryo frozen in Missouri. 

Zoll’s daughter, who is 2 years old, was conceived through in vitro fertilization. But during that pregnancy Zoll developed Hellp Syndrome, an extreme and life-threatening case of preeclampsia. 

After giving birth to her daughter at 35 weeks, Zoll’s doctor advised her not to do so again out of fear that she wouldn’t survive another pregnancy. 

That warning left Zoll and her husband unsure of the best future for their last embryo. And the uncertainty turned to fear after an Alabama Supreme Court ruling in February. 

“Because of all we go through, (embryos) feel like more than just this clump of cells, because it’s this hope that you’ll be a parent one day,” Zoll said. “And you lose so much going through infertility.”

Zoll, like many Americans, was shocked when the Alabama Supreme Court ruled frozen embryos were “extrauterine children.” Several fertility clinics in that state immediately stopped  IVF for fear of being found liable for wrongful death if they accidentally destroyed an embryo.

Floored by the news and the unknown, Zoll reached out to her state senator, Tracy McCreery, an Olivette Democrat. This is scary, Zoll told her. Can you do something?

McCreery would later reference stories like Zoll’s on the Senate floor, but ultimately wasn’t able to push through legislation to protect the procedure. 

A handful of attempts to protect IVF through the legislative process were introduced, but didn’t make it far in either the House or Senate. In part, the reluctance stemmed from a belief that IVF wasn’t in immediate danger, and therefore was an issue for a different year as more urgent matters — and Senate dysfunction — often ruled the day. 

But advocates for IVF say the lack of urgency was a mistake. They believe ambiguity in state law leaves IVF vulnerable to the same conclusion reached by Alabama’s highest court.

McCreery’s bill, which would have excluded IVF from any “unborn children” language in Missouri law, never got a Senate hearing.

“Unfortunately in the legislature,” McCreery said, “there just weren’t people willing to have that discussion.” 

House Majority Leader Jon Patterson, a Lee’s Summit Republican and a physician, said many Republicans, himself included, are eager to put more protections in place. But in the House, he said IVF legislation came too late in the session to realistically act on what he called a preemptive bill.

“Going forward, protecting Missouri parents’ ability to access in vitro fertilization will be a priority,” said Patterson, who is expected to become speaker of the House next session.  Lawmakers, he said, “need to do everything we can to protect access to IVF.”

IVF, the process of collecting a woman’s eggs, fertilizing them with sperm in a laboratory and transferring resulting embryos to her uterus or freezing them for later, has become increasingly common. It gives people the opportunity to both start families later in life and grow families in spite of illness or infertility.

In 2021, more than 97,000 babies were born thanks to assisted reproductive technology, more than double the number a decade earlier, according to the CDC.

While many Missouri Republicans voiced support for IVF, in the wake of the Alabama ruling a few spoke out against the procedure, arguing families should only create as many embryos as they intend to use, running counter to how the process currently works. 

“I’ve got a group of colleagues that believe that what happened in Alabama could happen in Missouri,” McCreery said. “But like a lot of things in the state of Missouri, people just cross their fingers and hope that there isn’t a problem.”

‘No protection for IVF’

In an attempt to start answering his clients many questions after the Alabama decision came down, Tim Schlesinger, a surrogacy and assisted reproductive technologies attorney in St. Louis, took to a blog post. 

“This case has no direct legal impact outside the State of Alabama,” he assured Missourians. 

In a recent interview with The Independent, Schlesinger said this still holds water. But it also stands alongside another truth in Missouri: “There is no protection for IVF right now.”

He’s carefully watched the ripple effect of the Alabama decision move north. 

He doesn’t believe IVF is at risk of disappearing in Missouri, but without legislation that protects both patients and clinics, he said it’s not impossible for Missourians to find themselves in a situation similar to Alabama.

Schlesinger knows the topic well. Several years ago he litigated the case that set the precedent for defining an embryo as “property of a special character.”

That case, McQueen v. Gadberry, arose from a custody dispute over embryos in a divorce. 

Schlesinger, who represented Gadberry — the ex-husband who didn’t want his ex-wife to use the remaining embryos to create children, and won — said the outcome confirmed patients have the right to decide what to do with their pre-embryos.

But Michael Wolff, a former Missouri Supreme Court chief justice and dean emeritus at St. Louis University School of Law, fears the overturning of Roe v. Wade, a case cited in the McQueen v. Gadberry decision, means the precedent set by the judge’s decision would no longer apply if brought before a court again.

Missouri law states that all life begins at conception.  Wolff interprets conception and fertilization to be one in the same in regards to state law, adding that it would simply take “an overeager prosecutor” for Missouri to find itself in a position similar to Alabama.

“I’m not being an alarmist about this, I’m not being an extremist. I’m not saying that everybody should believe that what the legislature says is true,” Wolff said. “But I think you have to take seriously what the legislature says. They were perfectly serious when they wrote it as far as I can tell.”

After Missouri banned abortion, the state saw 25% drop in OB-GYN residency applicants

Schlesinger is hopeful that if a state court was faced with a case similar to McQueen v. Gadberry today, it would come to the same conclusion it did several years ago, since he said that case wasn’t premised on Roe v. Wade. 

But, he added, there’s no guarantee the judges now sitting on the Missouri Supreme Court would agree. 

“That’s a legitimate concern, and an insightful concern brought up by Judge Wolff, but in my opinion, the overturn of Roe v. Wade should not impact McQueen v. Gadberry,” he said. “Because the reason for the overturn of Roe v Wade was not relevant to what is the character of a pre-embryo.”

Schlesinger said a more immediate impact he’s considering is on doctors. 

“The people who live in Missouri and want to have outstanding fertility care in Missouri might be impacted just by physicians reluctant to expand within Missouri until enough time has passed that they see how efforts in this regard are going to shake out,” he said.

Failed legislative attempt to protect IVF

As Missouri senators debated legislation blocking Planned Parenthood clinics from receiving Medicaid reimbursements, McCreery brought forward an amendment that would exempt IVF from Missouri’s current statute which states that life begins at conception. 

“I assumed wrongly, stupidly, that when the legislature passed a total ban on abortion, that that would be enough. People would feel like they had their Pro-Life credentials,” state Sen. Lauren Arthur, a Democrat from Kansas City, said during the debate. “What I have since realized is, it’s never enough.”

The amendment never made it to a vote, but it fueled much of the Democratic senators’ filibuster that April evening. 

But unlike inside the statehouse, McCreery believes the issue remains largely a nonpartisan one. Conservative voters have reached out asking for her help protecting the procedure. 

After the Alabama decision, Republican state Rep. Bill Allen of Kansas City consulted his priest, who encouraged him to look around the church at the children born through IVF.

“That helped square my faith and politics, I’ll tell ya,” Allen said, adding: “To me it was the right thing to do for Missouri families, and I just wanted to protect it.”

In late February he filed legislation that would have clarified the right to IVF. His bill, like McCreery’s, was never granted a committee hearing.

Allen plans to file the bill again next year, if re-elected.

“There may have been election year politics that got in the way this time,” he said. “But with those removed next year, I’m really optimistic that this can get through as a priority.”

Conservative opposition

While IVF remains a fairly bi-partisan issue, some hold-outs remain.

During a Missouri Freedom Caucus press conference this spring, state Sen. Rick Brattin, a Harrisonville Republican, decried the current IVF process as the “reckless storage and disposal of human life.” 

Often, several embryos are created at once, in part because many don’t survive to the point of implantation in the womb. It’s common practice to immediately freeze any embryos created, even if the intention is to implant them quickly.

“If you’re getting in vitro fertilization, it needs to be the embryos that are going to be implanted at that particular time,” Brattin said. “I know it’s an expensive process, but creating this huge inventory of life being frozen, I don’t agree with it.” 

He proposed that families create an embryo, and then if unsuccessful, come back and create another one. Brattin could not be reached for comment. 

After the Alabama decision, many Republicans spoke up in favor of the current IVF process. But others, like Brattin, stood by a long-held anti-abortion belief that embryos should not be stored, discarded or used for science.

During a mid-March Senate debate on an education bill, state Sen. Mike Moon, a Republican from Ash Grove, was asked by Arthur if he believed IVF should be allowed. Moon had proposed an amendment which would have required students be taught that life begins at conception.

“If I were the one with the magic wand, I would have discouraged it because now you’ve got how many fertilized embryos out there? And what happens if that facility where they’re housed loses power and they all die? Who’s culpable?” Moon said. “And so I think we’ve created a problem, and we created it. Only God’s supposed to create in that fashion. And we’ve taken it upon ourselves to do it.”

Abolish Abortion Missouri leader Wesley Scroggins, who has endorsed Moon, called IVF “sinful” at a rally in Jefferson City following the Alabama ruling.

The Missouri GOP website, under a page titled “faith and family,” lists support for “the protection of the lives of in vitro fertilized embryos and all other human embryos from the beginning of biological development” just below its support for marriage between “one man and one woman.”

Asked about IVF during a KSDK interview in March, state Sen. Mary Elizabeth Coleman, a Republican from Arnold and a leading anti-abortion lawmaker, said Missouri already has some of the most “permissive” IVF laws in the country, so she saw no further need to protect the process through legislation.

She noted that since the passage of the Missouri Stands for the Unborn Act in 2019, there’s been no litigation filed against I.V.F.

“If Missouri was going to do something, they would’ve needed to already address it,” she said.

In the days following the Alabama decision, lawmakers in that state passed a law shielding IVF clinics and providers from civil and criminal liability, raising concerns that while such a law allowed clinics to reopen immediately, it also prevented families from having the ability to sue if something went wrong.

Asked in March if she’d support a law to more clearly protect I.V.F., Coleman said she would be hesitant.

“Because it’s broadly legal right now,” Coleman said. “I wouldn’t want to enact something that would actually make it harder for a family who would receive malpractice in their medical practice to be able to be made whole.”

Lingering effects of Alabama decision

As president of the Midwest Reproductive Symposium International, Dr. Amber Cooper looks forward to discussing emerging technologies and advancing access to care at the annual gathering. 

But this year, the Alabama decision lingered like a shadow over the group. 

“We’ve had to pivot and discuss ‘how do we protect patients, patients’ decisions? How do we protect embryos in storage? How do we protect clinics, particularly in states that are more threatened by some of these political decisions?’” said Cooper, a board certified reproductive endocrinologist and medical director for fertility clinic Kindbody St. Louis, who led this year’s conference, happening this week in Chicago.

She said a lot of misunderstanding around IVF has emerged in mainstream conversations since this spring, including a belief that many patients have numerous excess embryos in storage.

Cooper said it’s lucky if even 20% of the embryos created result in a live birth. 

Creating only one embryo to use at a time is unrealistic, she said, and overlooks considerations including rapidly declining egg pools, patients undergoing cancer treatment and patients with genetic diseases. 

“If we only create one embryo at a time, the success of IVF becomes profoundly lower,” she said. “And in a country where (health plans) don’t often pay for IVF … the access to care, and the affordability becomes the biggest issue of all.“

Cooper said many of her Missouri patients have asked about storing their embryos across the river in Illinois, where reproductive rights are more expansive. Larger nationwide fertility clinics are also considering where to grow and expand. Right now, Cooper said, red states look less appealing than blue ones.

“I think IVF still could be at risk,” Cooper said. “I don’t think we’re quite there yet in Missouri, compared to some other states. But it’s still a state where we are nervous that it could be.”

Legislation, she said, would be the most effective way to alleviate that concern.

The U.S. Senate might take up legislation to protect IVF access on a federal level as soon as this week. Last week, Senate Republicans blocked a bill from moving forward to vote on reinforcing access to contraception. Missouri Sens. Josh Hawley and Eric Schmitt were among the Republicans who blocked the legislation. 

Another possible protection lies in an initiative petition campaign hoping to ask Missouri voters if they want to legalize abortion up to the point of fetal viability. The amendment, if approved for the November ballot, reads, in part: “The government shall not deny or infringe upon a person’s fundamental right to reproductive freedom.” 

Waiting and worrying

While IVF has largely faded from the headlines in recent weeks, people struggling to grow their families across Missouri still grapple with concerns sparked by the Alabama news.

Maddie Bobbitt and her husband Jerel have been trying to conceive since December 2019. 

One egg retrieval, six frozen embryos and two miscarriages later, they’re waiting to implant their remaining two embryos in August. 

About one in five married women between the ages of 15 and 49 experience infertility in America, meaning they are unable to get pregnant within the first year of trying, according to the Centers for Disease Control and Prevention. 

In St. Louis, where Bobbitt lives, it’s  one in six couples.

“But when you are the one in six, you know, it feels like one in 6 million, it feels like you are the only one,” Bobbitt said.

When news of the Alabama decision came as Bobbitt, 33, was in the thick of IVF, she was filled with rage.

“IVF in and of itself is so unbelievably stressful and heartbreaking, and just very traumatic,” Bobbitt said. “When you add on top of it that we live in a very conservative, red state, that just adds an extra layer of stress and angst and being afraid for my own personal health and wellbeing and safety.”

Jovonna Jones, 35, who is undergoing infertility treatment, considered traveling to Mexico to finish her current round of IVF when she and her husband, Donovan, heard the news. But for now, they’re continuing to see their doctor in St. Louis.

“You really don’t have room for stress,” Jones said. “Because your body needs to be as calm as possible so those follicles can continue to grow.”

So far she and her husband have undergone five IVF cycles. They’ve taken out two loans and hosted numerous fundraisers to afford the $70,000 they’ve paid out of pocket in the hopes of making Jones’ husband a father. 

She has four children of her own from a previous relationship.

Missouri is not among the growing number of states that mandate some form of infertility coverage, despite efforts by some lawmakers to require insurance coverage for the process to help alleviate some of the financial burden that comes with growing a family through IVF

Zoll, the St. Louis mother who petitioned her state senator earlier this year to protect the procedure, watches her daughter play with baby dolls and fiercely hopes she won’t also experience the toll of infertility.

“IVF is one of the most pro life things I’ve ever heard,” said Zoll, who runs an infertility-focused nonprofit in St. Louis called Making a Miracle, “How can you try and take that away? The impact would be just detrimental to so many families, because it’s our right to have children and build them.”

Missouri Attorney General Andrew Bailey (photo submitted).

Planned Parenthood is asking a Missouri judge to dismiss a lawsuit filed by the state’s attorney general alleging the clinic is transporting minors out of state for abortions. 

The lawsuit was filed based on an undercover video filmed by a man affiliated with a right-wing group pretending to be the uncle of a 13-year-old in need of an abortion whose parents couldn’t know.

Missouri Attorney General Andrew Bailey wrote on social media Monday that the lawsuit filed in February is the latest step in a years-long attempt to “drive Planned Parenthood out of Missouri.” 

“It is time to eradicate Planned Parenthood once and for all to end this pattern of abhorrent, unethical, and illegal behavior,” he wrote.

Planned Parenthood continues to argue it has not broken the law, pointing to the “fictitious” nature of the video.

Judge Brouck Jacobs presided over the hearing Monday afternoon in Boone County. The lawsuit was brought against Planned Parenthood Great Plains, which has Missouri clinics in the Kansas City region and Columbia.

“There is no allegation that any child, any minor has been taken across state lines; there’s no allegation that any parent has complained,” John Andrew Hirth argued on behalf of Planned Parenthood. “There’s no allegation that any abortion has been performed either in Missouri or outside of Missouri, with or without parental consent here. The whole conversation is hypothetical.”

Jacobs asked Kathryn Monroe, representing the attorney general’s office, if she agreed. 

Monroe said while there was no 13-year-old girl in the video, and the man’s questions were hypothetical, the employee at Planned Parenthood thought the situation was real. 

“There was admitted conduct about what they would do in this actual situation,” she said.

The video, captured in December at a Planned Parenthood clinic in the Kansas City area, was later posted on social media by Project Veritas, a self-proclaimed conservative news organization founded in 2010 that often conducts undercover stings that are ultimately disproven. Its now-ousted founder, James O’Keefe, is currently under investigation by New York authorities, and the organization has a long history of spreading claims that are later discredited. 

In 2015, Project Veritas released a video purporting to show Planned Parenthood selling fetal tissues from abortions in violation of federal law. That led to an investigation by Missouri lawmakers that was unable to substantiate any such sales by Missouri-based Planned Parenthood affiliates.

In the video from Kansas City, the made-up girl’s parents couldn’t know about the abortion, the man secretly taping the interaction for Project Veritas told the Planned Parenthood employees. Staff then directed him to their affiliate clinics in Kansas where they said he could “bypass” parental consent. 

When the man asked how often girls go out of state for abortions, the Planned Parenthood employee said it happens “every day.”

Monroe pointed to this quote, saying it shows Planned Parenthood could realistically be helping real minors access abortion now and in the future.

The attorney general’s office pointed to Missouri law which states: “No one shall intentionally cause aid or assist a minor to obtain an abortion.” 

That law was written before the state’s trigger law went into place in June 2022, effectively making all abortions — with the expectation of cases where the mother’s life is at risk — illegal.

After Missouri banned abortion, the state saw 25% drop in OB-GYN residency applicants

Missouri doesn’t have explicit laws requiring parental consent for minors getting abortions in other states, nor does it prohibit minors from going to other states to get abortions.

A spokesperson for Planned Parenthood Great Plains said in February that they do not provide any form of transportation directly to any patients, regardless of age or where they live. They also described the video, taken without staff’s knowledge, as “heavily doctored and edited.” 

Kansas law requires physicians to either obtain parental consent or to go through the judicial bypass process where a judge can authorize a minor to get an abortion without parental consent.

Hirth pointed to a 2007 case, Planned Parenthood v. Nixon, in which he said the court found that information or counseling given by Planned Parenthood — such as laying out a patients’ options in another state — would be considered free speech and would not be classified as aiding or assisting in abortions.

But the attorney general’s office argued that the Missouri clinic still aided in a hypothetical abortion, pointing to a point in the video where the employee says “we can cut off our letterhead so it doesn’t even say where she was,” in reference to a doctor’s note in order to miss school. The employee also says that Planned Parenthood often sets up hotels for those who need to travel out of state.

It’s not clear if “we” implies that specific clinic or Planned Parenthood in Kansas.

Monroe argued these offers represented “an active attempt to conceal where a minor was.” 

“If you call and let them know what’s going on, they’ll do whatever they can to help you,” the employee said, referring to the Kansas clinic locations.

The video does not show the employee physically setting up any doctor’s notes or calling to set up a hotel.

“The issue here is about conduct that happened in Kansas or is alleged to have happened in Kansas,” Hirth said. “Or it was alleged to happen in Kansas, hypothetically in the future.”

Hirth added that medical offices are not supposed to reveal what medical procedure a student misses  school for regardless of the reason. 

The hearing lasted about 40 minutes, at which point Jacobs said he took the issue under advisement.

The Project Veritas video has been widely shared by Missouri Republican lawmakers, and was referenced on the House and Senate floors during debates over a bill seeking to end Medicaid reimbursements to Planned Parenthood clinics in Missouri, which do not perform abortions but do provide services like cancer screenings, STI testing and contraceptives. 

That bill eventually passed despite Democrats’ attempts to kill it by filibustering. Gov. Mike Parson signed it into law this spring.

Hanna Sumpter, a spokesperson for Planned Parenthood Great Plains, said in a statement Monday that while the lawsuit is based on hypotheticals, she believes the harms of such a court filing are real.

“Ultimately, these attacks from anti-abortion groups and politicians hurt real patients –” she wrote. “Shaming and stigmatizing the safe and effective healthcare providers and services they need.”

(Jennifer Shutt/States Newsroom).

WASHINGTON — An attempt to reinforce Americans’ access to contraception failed Wednesday when U.S. Senate Republicans blocked a bill from advancing toward final passage.

The 51-39 procedural vote required at least 60 senators to move forward, but fell short after GOP lawmakers said the measure was too broad as well as unnecessary.

Alaska Sen. Lisa Murkowski and Maine Sen. Susan Collins, both Republicans, broke with their party and voted to advance the legislation. Missouri’s GOP senators, Josh Hawley and Eric Schmitt, both voted to block the bill from moving forward.

Democrats argued during debate on the 12-page bill that it would provide a safety net should a future Supreme Court overturn two cases that ensure married and unmarried Americans have the right to make decisions about when and how to use contraception.

GOP senators contended the vote was mere politics and that if Democrats were serious about safeguarding access to contraception for future generations, they’d work with Republicans on a bipartisan bill.

Nevada Democratic Sen. Jacky Rosen said the Supreme Court’s decision to overturn the constitutional right to an abortion in the Dobbs decision two years ago showed women how quickly things can change.

“It demonstrated that a fundamental right, the right of women to make decisions over their own bodies, could be taken away in the blink of an eye,” Rosen said.

Women, she said, can’t rely solely on the Supreme Court to uphold the cases that have guaranteed Americans access to contraception for more than 50 years.

“Contraception has been safely used by millions of women for decades,” Rosen said. “It’s allowed women to take control over their own bodies — to decide when they want to start a family, how many kids they have, who they want to start a family with.”

“For these very same reasons, the right to contraception has been a target of anti-choice extremists for years,” Rosen added.

Senate Minority Whip John Thune, the South Dakota Republican seeking to become the chamber’s next GOP leader, said the bill was meant to “provide a talking point for Democratic candidates.”

“These votes have nothing to do with legislating and everything to do with boosting Democrats’ electoral chances, he hopes, in this fall’s election,” Thune said, referring to Senate Majority Leader Chuck Schumer.

The legislation was a non-starter with many Republicans, Thune said, because it didn’t carve out the conscience protections that exist under the Religious Freedom Restoration Act.

The federal law, enacted in 1993 after being sponsored by Schumer, established “a heightened standard of review for government actions that substantially burden a person’s exercise of religion.”

Sales of contraceptives

Democrats’ bill would have protected “an individual’s ability to access contraceptives” and “a health care provider’s ability to provide contraceptives, contraception, and information related to contraception.”

The legislation would have barred state and federal governments from prohibiting the sale of any contraceptives or blocking “any individual from aiding another individual in voluntarily obtaining or using any contraceptives or contraceptive methods.”

The bill defined contraception as “an action taken to prevent pregnancy, including the use of contraceptives or fertility-awareness-based methods and sterilization procedures.”

House Democrats introduced an identical bill in that chamber on Tuesday, though it’s unlikely to get a vote while Republicans remain in control.

Following the vote, Schumer moved to schedule a procedural vote next week on legislation that would guarantee access to in vitro fertilization.

Schumer said during a press conference afterward that vote would give Americans an opportunity to “see where Republicans stand on the so very important issue” of reproductive rights.

Supreme Court opinion

Supreme Court Associate Justice Clarence Thomas stirred up concerns about access to contraception two years ago when he wrote a concurring opinion in the Dobbs case.

Thomas wrote that the justices should “reconsider all of this Court’s substantive due process precedents, including Griswold, Lawrence, and Obergefell.”

None of the other nine justices joined Thomas in writing that opinion, likely signaling they didn’t agree with some or all of it.

The 1965 Griswold v. Connecticut case was the first time the court recognized that married couples’ constitutional privacy rights extend to decisions about contraception. That ruling struck down a Connecticut state law that barred access to contraceptives.

The Supreme Court, in 1972, extended the right to make private decisions about contraception to unmarried people in the Eisenstadt v. Baird ruling.

Following the release of Thomas’ concurring opinion, Democrats and reproductive rights organizations immediately began pressing for federal laws that would reinforce current contraception access. Congress has not passed any so far.

Mini Timmaraju, president and chief executive officer of Reproductive Freedom for All, said during a press conference with Senate Democrats on Wednesday before the vote that women should talk with their mothers and grandmothers about when they were first able to obtain birth control.

“When we talk about the generations of women in this country who didn’t have access to birth control, we’re just talking about my mother’s generation — 1965,” Timmaraju said. “It was not that long ago and that should really be a wake-up call.”

‘Birth control is popular’

Michelle Trupiano, executive director of the Missouri Family Health Council, said Wednesday afternoon that Hawley and Schmitt’s vote shows “how disconnected our senators are from what Missourians actually want.”

Recent polling by The Right Time, a family planning initiative through the Missouri Family Health Council Inc., showed Missourians across the political spectrum overwhelmingly support access to contraceptives, but some fear their lawmakers could pass laws limiting that availability. 

About half the Republican respondents, 84% of the Democratic respondents and 61% of the independent respondents said they are very or somewhat concerned the legislature will push laws restricting birth control. 

“Birth control is popular– everyone knows someone who has used or currently relies on birth control,” Mallory Schwarz, executive director of Abortion Action Missouri, said in a statement Wednesday.

Jessica Estes is among the Missourians who attributes part of her success to birth control. 

In the 13 years between the births of her eldest two children, Estes graduated from high school and went on to earn a master’s degree from Washington University in St. Louis. 

Estes, now a 35-year-old mother of three in University City, gave birth to her first child the day after she turned 17. She had her second child after finishing school. 

“Reaching my academic goals opened up a wealth of opportunities professionally, which allowed me to have a level of stability that I would not have had if I didn’t have access to birth control,” Estes said. “To be able to make the right choice about when and if I would have more children.” 

But in those 13 years she didn’t always have access to birth control. As an undergraduate, she was hired into her first full-time job with benefits. When she went to the pharmacy to pick up her birth control refill, she learned that her employer, a Catholic organization, did not cover contraceptives. 

“I was afraid that for the first time in quite a while, I wasn’t going to have control over my life or my future,” she said. “I didn’t know what my next step was going to be.”  

Estes eventually was accepted into the Contraceptives Choice Project at Washington University, where she got her first intrauterine device, which was placed for five years, for free. Because she didn’t have a car at the time, this also helped guarantee her access, since she no longer had to drive to the pharmacy every few months with her toddler in tow.

“Women and birthing people in Missouri find birth control to be valuable, life-changing for the better, and vital to their life and success,” said Estes, who is now a social worker and also serves as vice chair of Abortion Action Missouri Foundation Board.

Ernst alternative proposal 

Iowa Republican Sen. Joni Ernst said during debate on the bill that Democrats’ legislation went too far and pressed for the Senate to take up a bill she introduced earlier this week.

The measure has since gained nine co-sponsors including Chuck Grassley of Iowa, Shelley Moore Capito of West Virginia, Steve Daines of Montana, Todd Young of Indiana, Thom Tillis of North Carolina, Ted Cruz of Texas, Mitch McConnell of Kentucky, James E. Risch of Idaho and John Cornyn of Texas.

Iowa Republican Rep. Ashley Hinson plans to introduce the companion bill in the House, according to an announcement from Ernst’s office.

“With my bill, we’re ensuring women 18 and over can walk into any pharmacy, whether in Red Oak, Iowa, or Washington, D.C., and purchase a safe and effective birth control option,” Ernst said. “This Republican bill creates a priority review designation for over-the-counter birth control options to encourage the FDA to act quickly.”

Ernst said she was “encouraged” that one over-the-counter oral contraceptive has been approved and is available, but that should be “just a starting point.”

The four-page bill would encourage the U.S. Food and Drug Administration to approve additional over-the-counter oral contraceptives and “direct the Comptroller General of the United States to conduct a study on federal funding of contraceptive methods.”

The legislation would require the secretary of the Health and Human Services Department to give priority review to a supplemental application for oral contraceptives “intended for routine use.” But it does not extend that to “any emergency contraceptive drug” or “any drug that is also approved for induced abortion.”

Access to over-the-counter oral birth control that receives FDA approval so that it no longer requires a prescription would be available for people over 18.

The need for more robust and accessible maternal health care is particularly stark in Missouri, where lawmakers on both sides of the aisle have lamented the state’s woeful maternal and infant mortality rates (Getty Images).

Medical students and residents increasingly come to Dr. Colleen McNicholas with the same concern: will their training in Missouri prepare them to competently care for pregnant patients? 

McNicholas, who for years was among the few doctors performing elective abortions in Missouri, said that fear is reflected in a report released in May by the Association of American Medical Colleges. It found Missouri had more than a 25% drop in applicants for OB-GYN medical residencies since 2022, when abortion became illegal in the state.

“What does it mean to be an OB-GYN in a state that is telling you how to practice medicine?” asked McNicholas, chief medical officer for Planned Parenthood of the St. Louis Region and Southwest Missouri and Missouri chair of the American College of Obstetricians and Gynecologists.

All 14 states with abortion bans saw a decrease in OB-GYN residency applications, despite a slight overall increase in physicians applying for OB-GYN residency programs nationally, the study found. Missouri was second only to Arizona for the largest decrease in applicants.

The need for more robust and accessible maternal health care is particularly stark in Missouri, where lawmakers on both sides of the aisle have lamented the state’s woeful maternal and infant mortality rates — among the worst in the country — and lack of maternal health care providers in nearly half of its counties. 

McNicholas said legal concerns aside, there are a couple things for doctors to consider when deciding where to do their residency, since historically, most physicians remain in the community where they do their training. 

Physicians tend to start families later in life, which means they are inherently at higher risk of having pregnancy complications or needing to use assisted reproductive technology, she said. And OB-GYNs are increasingly women, which means they need good maternal care if they choose to have a family.

“The need for more OB-GYNs is going to be at a crisis point here soon,” McNicholas said. “… You cannot even seriously consider how to fix that problem until you address the reality of what a workforce crisis looks like under an abortion ban.” 

State Sen. Mary Elizabeth Coleman, an Arnold Republican and a board member for Missouri Stands with Women, a group formed to fight a campaign to legalize abortion in Missouri, doesn’t think the study’s conclusions are valid. 

She instead pointed to other reasons she sees for declining OB-GYN residency numbers across the country, including a move by some universities to DEI-based admission and population declines, particularly in rural areas. 

Coleman accused the medical association of fear-mongering, adding that if physicians choose not to apply to Missouri because of its abortion ban, then they are doctors she’d prefer to stay away.  

“I wish they would focus on providing rural health care to Missourians,” she said. “Rather than a love affair with a violent procedure that ends a life.”

Alyssa Lally, a spokeswoman with the University of Missouri-Kansas City, said the school attributes fluctuations in OB-GYN residency applicants over the past several years in part to a change in how residents are now matched. 

Over the past few years, the national organization that handles residency applications stopped sending all OB-GYN applicants to all medical schools with the program, and instead started sending the applications of residents only to the schools they showed interest in attending.

Despite this, she said UMKC continues to fill all its residency slots. A spokesperson for the University of Missouri-Columbia’s medical school said it also has no problem filling their four openings each year.

Lisa Cox, a spokeswoman with the Missouri Department of Health and Senior Services, said the state is working to improve physician retention through its Graduate Medical Education Grant Program, which supports extra residency positions.

“It is difficult to pinpoint a single cause (of the drop); however, our main takeaway is that Missouri needs more residency spots. Of course, this is an issue nationally,” Cox said in a statement. “ … Our residency spots, while already low, are routinely filled, and it remains a competitive field, which could deter applicants.”

‘states with bans are reaping what they sow’

Pamela Merritt, the executive director of Medical Students for Choice, said she has a hard time selling medical students on coming to states with abortion bans.

“I don’t know anybody who’s invested close to half a million dollars in their education who wants to walk into a residency program in a state where people with absolutely no background in medicine are drafting regulations that deny your ability to care for your patients,” she said.

The data reflects this due diligence by medical students to research where they want to start a life and start a practice, she said.

And while she said states should be doing all they can to attract top talent, bans often have the opposite effect. 

“All of the states with bans are reaping what they sow,” Merritt said. “The tragedy is that the communities most harmed by this are rural communities and poor communities.”

She guesses public health outcomes will only worsen as a result.

Maternal mortality rates were 62% higher in states with abortion restrictions, according to a 2023 study published in the National Library of Medicine. 

A study from the state’s Pregnancy-Associated Mortality Review board found that between 2018 and 2020, 210 Missouri women died while pregnant, during childbirth or within a year of birth. The majority were deemed preventable.

Missouri also scored a D- grade for preterm births in a 2023 March of Dimes report.

Boone County new focus of Missouri initiative petition campaigns following redistricting

“Missouri already has indefensible maternal mortality rates,” Merritt said. “Missouri struggles to keep Black children who are born in the state alive for the first year after birth, and we have far too many young people who are living in poverty and are food insecure. 

“We’re failing children and failing families and women and this ban not only puts the health of people in Missouri who can experience pregnancy at risk, but it now is putting the health of everybody in the state at risk when you become repulsive to doctors, that’s very dangerous.”

More than 41% of counties in Missouri are designated maternity care deserts, meaning there are no maternity care providers or birthing facilities. Missouri’s rate is higher than the national rate of 32%, according to a separate 2023 report from the March of Dimes. Across the state, 10% of women do not live within 30 minutes of a birthing hospital.

In the last decade, 19 hospitals across Missouri have closed, according to the Missouri Hospital Association.

The state’s board of healing arts, which licenses physicians, reports there are 1,041 licensed OB-GYNs working in Missouri. The March of Dimes estimates that in 2022, there were 1.1 million women of childbearing age, which means there is approximately one OB-GYN for about every 1,050 of childbearing age in the state.

Attempts to further limit training in abortion

During a House hearing earlier this year, state Rep. Emily Weber, a Democrat from Kansas City, said she’s heard about doctors first consulting attorneys before helping women in need of emergency abortions. 

Under the state’s “trigger law,” health care providers who perform abortions not necessary to save the woman’s life can be charged with a class B felony, which means up to 15 years in prison. Their medical license can also be suspended or revoked as a result.

The only exception is in cases of medical emergencies when a pregnant person’s life is at risk or when “a delay will create a serious risk of substantial and irreversible physical impairment of a major bodily function.”

“We’re losing physicians and doctors,” Weber said. “They’re leaving the state of Missouri because they can’t perform their actual duties that they had extensive education on and got their degree in.” 

House Minority Leader Crystal Quade pointed to some bills filed this year that didn’t pass, but that put Missouri on the national stage for “extremism,” likely to impact physicians’ decisions on whether or not to move to the state or out of it. 

This included a bill from state Rep. Justin Sparks, a Republican from Wildwood, that would have prohibited public and private medical schools from providing any “abortion-specific training,” including through out-of-state partnerships; and a bill filed by state Sen. Mike Moon, a Republican from Ash Grove, proposed to charge those who perform or get an abortion with murder. 

“It’s a perfect storm situation where we are continuing to lose access to care, particularly for maternal care,” said Quade, who is seeking the Democratic nomination for governor.

Quade has spoken with women who said they were sent home during a miscarriage because their life wasn’t yet in enough danger to get an abortion, and she’s spoken with providers who were unsure whether to stay in Missouri, weighing a moral dilemma between their duty to their patients and their fears of legal prosecution if they perform an abortion the state deems unnecessary. 

She, too, fears this decrease in interest in Missouri as a place for providers not just to learn, but to establish roots, will only continue.

“What that means is not only potential shortages,” Quade said. “But also that we’re not getting the best of the best anymore.” 

Sparks said his legislation wasn’t meant to target OB-GYNs, but rather was written based on conversations with Missouri physicians. He hoped to instead end “abortion fellowships” where doctors are sent across state lines to perform abortions. 

Those conversations, he said, included doctors at Washington University in St. Louis who said their students went out of state in order to “become really good at abortions, and then come back to Missouri to perform them in the cases where they’re legal.”

Sparks said this argument doesn’t hold water for him, since universities already teach a standard of care for emergency abortions that he finds to be sufficient.

“To say that we just have to do abortions in order to maintain that level of care is disingenuous,” he said, adding that physicians going out of state for training contributes to “a generation of folks who won’t exist.”

He thinks it’s a stretch to correlate the decrease in OB-GYN applicants with abortion bans, but added that Missouri would not be an appealing state for physicians wanting to go into the “abortion industry.”

A national database run by The Heritage Foundation, a conservative think tank, shows that there have been fewer than 100 cases of voter fraud tied to noncitizens since 2002 (Mario Tama/Getty Images).

Missouri’s Constitution has banned noncitizens from voting since 1924. And state law requires individuals to verify they are a U.S. citizen in order to register to vote. 

But GOP lawmakers contend the constitutional and statutory language isn’t strong enough. Instead of saying that “all citizens” can vote, Republicans argue the state constitution should be changed to make it clear that “only citizens” can vote. 

So on the final day of the 2024 legislative session last month, the GOP pushed through a proposal that would, among other things, ask voters to change “all” to “only.” 

“If they become a citizen, then absolutely I would welcome their engagement in our electoral process,” state Sen. Ben Brown, a Republican from Washington, said while presenting the bill to a House committee. “However, what I aim to do is to prevent the dilution of the voice of U.S. citizens.”

Critics painted the proposal as nothing more than “ballot candy” designed to stoke anti-immigrant sentiment and trick voters into signing off on the amendment’s other provision — a ban on ranked-choice voting. 

Marilyn McLeod, president of the League of Women Voters of Missouri, called the proposal a “red herring” at a legislative hearing last month.  

“It’s already against the law,” she said. 

Missouri initiative petition bill, a top GOP priority, dies on final day of session

The idea that noncitizens could be illegally voting has become an election-year talking point for Republicans across the country, often echoing the baseless conspiracy theory spread by former President Donald Trump that millions of undocumented immigrants voted in the 2016 election. 

A nationwide survey by the Brennan Center for Justice found the number of noncitizens suspected to have voted in the 2016 election was only around 30. A national database run by The Heritage Foundation, a conservative think tank, shows that there have been fewer than 100 cases of voter fraud tied to noncitizens since 2002, according to a recent count by The Washington Post.

The Ohio Secretary of State’s Office this year announced only 137 suspected noncitizens were discovered to be on that state’s rolls out of roughly 8 million voters. And the Georgia Secretary of State’s Office found that 1,634 noncitizens attempted to register to vote over a 25 year period, but all had been blocked by local election officials. 

Yet in some states, even though noncitizens are prohibited from voting in federal elections, they have been permitted to cast a ballot for local candidates. 

In 16 cities and towns in California, Maryland and Vermont, noncitizens are allowed to vote in some local elections, such as for school board or city council. In 2022, New York’s State Supreme Court struck down New York City’s 2021 ordinance that allowed noncitizens to vote in local elections, ruling it violated the state constitution.

State Sen. Bill Eigel, a Weldon Spring Republican and a candidate for governor, said the language in the Missouri Constitution designed to prohibit noncitizen voting is similar to other states where the practice is taking place locally. 

He believes Democrats in Missouri could follow suit.

“So do I think that if (St. Louis) Mayor Tishaura Jones thought that there was an opportunity to start engaging noncitizens to vote in local St. Louis city municipal elections, would she do it using the same procedure that’s happened to these other states?” he said. “I absolutely think she would. So for me, it’s important to put these additional protections in the constitution.” 

Already illegal? 

In 1865, Missouri voters approved a new constitution abolishing slavery. The 1865 “Drake Constitution,” written by what were called Radical Republicans, took the vote away from former Confederates and extended it to immigrants who were not yet citizens but who had declared their intent to become one.

The provision rewarded the largest immigrant group in Missouri at the time, Germans, who were among the most anti-slavery, and therefore Radical Republican voters. 

The franchise was taken away from noncitizens in 1924, when newcomers were more likely to come from eastern and southern Europe, in an amendment proposed by a state Constitutional Convention passed with 53.5% of the vote.

In addition to the century-old constitutional prohibition, state law also requires Missourians to declare whether they are a U.S. citizen when registering to vote. And Missouri Secretary of State Jay Aschroft, a Republican and candidate for governor, has repeatedly clarified over the years that state law says “you have to be a citizen to register to vote.”

Much of Missouri’s debate this year about noncitizen voting took place as part of a session-long fight over a Republican push to make it harder to amend the state constitution through the initiative petition process. 

A campaign to legalize abortion up to the point of fetal viability submitted more than 380,000 signatures to the Missouri Secretary of State’s office, paving the way for the proposed constitutional amendment to potentially land on the November ballot.

In response, Republicans hoped to raise the threshold for amending the constitution from a simple majority statewide to both a majority of votes statewide and a majority of votes in five of the state’s eight congressional districts.

Under that proposal, approximately 23% of voters could theoretically control the outcome, where a vote against an amendment in four districts would be enough to defeat it statewide.

Many Republican proponents of raising the bar for amending the constitution acknowledged its chances of winning voter approval was slim. 

“Raising the threshold is a loser and various states have proven that’s a loser,” Tim Jones, state director of the Missouri Freedom Caucus, said earlier this year. 

So to bolster the amendment’s chances, Republicans added the noncitizen voting provision. 

Senate Democrats refused to allow the proposal to go to the ballot with the noncitizen language, arguing it was deceptive. They staged a 50-hour filibuster that ultimately killed the proposal amid Republican infighting. 

“It’s in there to deceive voters,” state Sen. Karla May, a St. Louis Democrat, said during the filibuster about the noncitizen voting ban. “It’s already law, but they want to trick voters into thinking it’s not law. It’s deceiving language added to the bill.”

Gov. Mike Parson, a Republican, seemed to agree, telling a reporter from Nextar Media Group that “it’s already illegal for an illegal to vote in the state of Missouri. We’ve already got that part.”

With the Senate mired in gridlock, the House picked up and passed the rank-choice voting amendment that included noncitizen provision. After months of heated debate over the issue, it was barely mentioned when the rank-choice voting ban was sent to the ballot on the session’s final day.

“It seems like we’ve been wringing our hands for about a week or two on this particular issue,” state Rep. Brad Banderman, a St. Clair Republican, said during the House debate, “but on this day, on this Senate Joint Resolution, the other side of the aisle doesn’t seem to be standing at mics complaining.”

Petitioners with Missourians for Healthy Families and Fair Wages unload dozens of boxes of signatures on May 1 for delivery to the Secretary of State. (Annelise Hanshaw/Missouri Independent).

Since being elected Boone County Clerk in 2018, Brianna Lennon’s job verifying initiative petition signatures has been pretty easy, with only a few hundred pages to sort through at most. 

That changed after state lawmakers cut her county in half when they redrew Congressional maps. 

In 2022, after long-fought battles and filibusters over the new congressional map that must be redrawn every decade, Missouri lawmakers ultimately decided to split Boone County and Columbia between the 3rd and 4th congressional districts.

As a result, Lennon’s office went from having a few hundred pages of signatures to verify to more than 15,600 pages across four campaigns this year. 

“We’ve definitely seen that circulators feel differently about Boone County, because we’ve gotten more petition pages than we’ve gotten in years,” Lennon said. “And that’s the case for all the petitions that have been circulated this year.” 

The increased workload for the Boone County Clerk’s office isn’t the only possible ramification of the new congressional map. By splitting Columbia — a Democratic stronghold and a population center — into two districts, some argue lawmakers inadvertently eased the path of initiative petitions that need enough signatures in at least six districts  to get on the statewide ballot. 

This dynamic could be especially important for a campaign seeking to restore abortion access in Missouri, allowing signature gathering resources to be focused on friendly territory of a college town instead of more rural parts of the state that tend to skew conservative.

Three of the four campaigns seeking to put issues on the ballot this year — enshrining abortion in the constitution, mandating paid sick leave and raising the state’s minimum wage, legalizing sports wagering — turned in signatures in all eight of Missouri’s congressional districts. A campaign hoping to authorize a new casino near Lake of the Ozarks skipped the 6th and 8th districts.

“In their effort to stick it to Boone County, what they really did was they empowered Boone County to help issues qualify for the initiative petition,” said Stephen Webber, a Columbia Democrat running for state Senate and a former chairman of the Missouri Democratic Party. “If an (initiative petition) is successful, I think Boone County can be proud that we played a large role in making that happen.”

Not everyone is convinced the Boone County split will make much of a difference.

“Signature collecting campaigns are hard, and you’ve got to go find voters and you’ve got to find a lot of them,” said Sean Nicholson, a long-time progressive activist who has worked on multiple initiative petition campaigns. “It’s hard no matter what.”

While Columbia may have the appeal of being in two districts, Nicholson said that comes with the trade-off of having a lot of renters and students who may not be registered to vote in the county or who haven’t updated their address. 

Redistricting simply made campaigns rethink their strategies.

“The campaigns that win,” he said, “campaign everywhere.” 

‘Most important place for the pro-choice movement’

Earlier this month, three citizen-led campaigns proposing constitutional changes turned in hundreds of boxes filled with thousands of pages of signatures to the Secretary of State’s Office to be verified. If each was successful in getting valid signatures from 8% of citizens in six of Missouri’s eight congressional districts, their issue will be on the statewide ballot later this year. 

But the effort to roll back Missouri’s near-total ban on abortion has gotten by far the most attention. 

In February, while speaking at the Boone County Democrats annual chili supper, Webber made a prediction for the “blue island in the sea of mid-Missouri red.”

“The most important place for the pro-choice movement in 2024 is Boone County, Missouri,” he said, referring specifically to the fact that it now sits in both the 3rd and 4th congressional districts.

According to records obtained by The Independent through Missouri’s Sunshine Law, the abortion initiative petition turned in the most pages of signatures from St. Louis County, followed by Jackson and St. Charles counties. 

Boone County yielded the sixth-highest page count. For the sports betting and casino petitions, it was the fourth-highest page count.

The number of signatures per county or per congressional district is not yet clear, only the number of signatures pages turned in. Those pages can include up to 10 signatures. 

Lennon said Boone County is a compact population center surrounded by rural counties. Now that the county is split in half, the return on investment for initiative petition campaigns is more worthwhile.

‘It’s hard no matter what’

Missouri Senate President Pro Tem Caleb Rowden, a Republican from Columbia, may have been one of the only lawmakers thinking about the initiative petition process in 2022 as he opposed a 7-1 map supported by Missouri Right to Life that would have split the Kansas City district, including it with rural counties in the hopes of flipping those seats for Republicans.

At the time, Rowden said splitting up more populous, liberal areas could make it easier for left-leaning groups to get abortion measures on the ballot by taking advantage of districts’ urban centers. 

Rowden could not be reached for comment this week. 

The 7-1 proposal pushed by the Senate’s conservative caucus was ultimately defeated in favor of a 6-2 map that maintained six safe Republican districts and two Democratic districts in Kansas City and St. Louis.

State Sen. Andrew Koenig, a Republican from Manchester and a member of the Senate Freedom Caucus, said he did not recall the initiative petition campaigns factoring into his decision to vote against the final 7-1 map.

“Honestly just getting something passed was the main goal at that point in time,” Koenig said. “There was a lot of disagreement amongst different senators on how to draw those maps, and so when it came to the (initiative petition) process, that at least never entered my mind on the redistricting part.” 

Koenig added that he thought Rowden’s comments were “a talking point,” lacking merit. 

Whether any of the initiative petition campaigns end up on the ballot remains to be seen, but there’s no denying Boone County is getting a lot more attention this year. 

Missouri initiative petition bill, a top GOP priority, dies on final day of session

Marc Ellinger, a Republican and former attorney for the 2022 campaign to legalize recreational marijuana, said there’s certainly an assumption, whether right or wrong, that Boone County’s going to be “more receptive to abortion rights and therefore more likely to find willing signers.”

Based on initial page counts, the abortion campaign appears to have focused the least amount of its effort on the 6th District in northern Missouri and the 8th District in southeast Missouri. Ellinger said that’s likely because Clay County, which includes some of Kansas City, is now in the 5th District, and because the 8th District is too rural. 

It makes sense for campaigns to flock to populous areas, said Eric Fey, Democratic director of elections for the St. Louis County Election Board. 

There are also challenges. For example, Fey said, in St. Louis, registered voters often don’t know if they live in the city or county, so they will sign the wrong sheet, invalidating the rest of the signatures on it. 

The most accurate petition pages they see often come from circulators outside polling places on election day, Fey said, or those who go door-to-door with a list of registered voters in hand. It’s what can make collecting signatures in more rural areas with lots of homeowners end up with a higher success rate of valid signatures.

Plans to challenge abortion petition

While many Missouri leaders have been speaking about the abortion campaign as if it’s already secured a spot on the ballot, Sam Lee, a longtime anti-abortion activist and lobbyist, isn’t conceding yet. 

He is part of a campaign called Missouri Stands with Women, established to fight the abortion coalition. While they’ve been vastly out-fundraised by the abortion rights campaign, Lee said his group has other tactics in mind. 

Lee pointed out that campaigns with similar signature totals have either failed or been close to failure in recent years. 

In 2022, a ranked choice voting ballot initiative collected more than 303,000 signatures but did not meet the required signature total in any congressional district. The campaign to legalize recreational marijuana collected nearly 400,000 signatures but nearly missed out in the 6th district  with just 806 more than required. 

The abortion campaign announced on May 3 that they turned in 380,159 signatures from every county in Missouri. A breakdown of how many signatures came from each district, which will ultimately determine if they met the threshold needed to qualify, is being determined by each county’s election authorities now. 

If the signatures are verified as sufficient by the Secretary of State’s Office, anti-abortion groups still plan to look at the signatures independently, Lee said. During the Midwest March for Life earlier this month, Susan Klein, executive director with Missouri Right to Life, said they plan to make sure any names she says were scratched out by people who regretted signing are not counted.

“We’re going to scrutinize these and leave all our options open,” Lee said Wednesday. “If we have to file a lawsuit to have courts determine it should not be on the ballot if it’s determined to be a sufficient number of signatures, we’re willing to do that.”

The Missouri House approved a non-citizen voting provision as part of a Senate bill which will put a question before Missouri voters seeking to ban ranked-choice voting and non-citizen voting (Stephen Maturen/Getty Images).

Arguments over the validity of banning non-citizen voting in Missouri, which is already illegal, were part of what ultimately killed an initiative petition bill prioritized by Republicans this session.

But in the final hours of the legislative session on Friday, the House approved a non-citizen voting provision as part of a Senate bill which will put a question before Missouri voters seeking to ban ranked-choice voting, or ranking candidates in order of preference.

“Missourians don’t want more voter confusion and exhaustion when they go to the ballot box than they already have,” said the bill’s sponsor, state Rep. Ben Baker, a Neosho Republican.

If approved by voters later this year, Missouri will officially ban ranked-choice voting and non-citizen voting. It would also confirm that elections only be carried out by paper ballot or “any mechanical method prescribed by law.”

The ranked-choice voting language has a carve-out for any “nonpartisan municipal election” that already has a ranked-choice ordinance in place. This applies to St. Louis. 

An initiative petition campaign in 2022 sought to amend Missouri’s Constitution to change the voting process for the general elections for state offices. In the primary, voters would have still only been able to cast one vote, but in the general election, they could list their preferences. The candidate to win the majority of first-choice votes would win. But if no candidate received a majority, the candidate with the fewest top-choice votes would be eliminated; the remaining votes would be distributed among the candidates left based on preferences. Whoever received a majority of those votes would win.

That proposal failed to gather enough signatures to go to the voters. 

The bill passed on Friday down party lines 97 to 43, with state Rep. Raychel Proudie, a Democrat from Ferguson, and state. Rep. LaKeySha Bosley, a Democrat from St. Louis, voting present. 

Missouri initiative petition bill, a top GOP priority, dies on final day of session

“This is wholly unnecessary,” state Rep. Eric Woods, a Democrat from Kansas City, said Friday of the bill.

That was the resounding cry from Senate Democrats earlier this week, as they filibustered for 50 hours in a successful attempt to stop a plan by Republicans to put a ballot measure before voters in the fall that would raise the threshold for amending the constitution by citizen-led initiative petitions. 

Democrats refused to let the initiative petition bill pass through the Senate as long as it included “ballot candy.” These provisions meant to entice voters into supporting the measure included a question about non-citizen voting and foreign interference.

Despite the hours spent this session debating the merits of the non-citizen language in the initiative petition bill, the topic didn’t immediately come up on the House floor Friday. 

Toward the end of debate, state Rep. Brad Banderman, a Republican from St. Clair, noted the “robust conversation” in both chambers over non-citizen voting the past couple of years, escalating in the final weeks of session. 

“It seems like we’ve been wringing our hands for about a week or two on this particular issue, but on this day,” Banderman said. “ … The other side of the aisle doesn’t seem to be standing at mics complaining 

Missouri House Speaker Dean Plocher addresses media May 17, the final day of the legislative session. (Anna Spoerre/Missouri Independent).

The Missouri Senate put its dysfunction on display one last time Friday when it adjourned minutes after reconvening, effectively killing efforts to send voters a ballot measure changing the majority needed to pass constitutional amendments.

The decision to quit almost eight hours before the constitutional deadline shows how little tolerance Republican leadership had for remaining in the same room with their factional foes in the Missouri Freedom Caucus.

The motion to adjourn was made by Senate Majority Leader Cindy O’Laughlin, who said that after days of ugly confrontations between senators, “I thought it would be good to end in a more cordial way.”

The Missouri House continued to work on legislation. The only notice taken of the Senate’s absence was a burst of laughter when the clerk announced there were “no messages to be read in from the Senate.”

Just an hour before the Senate quit for the day, House Speaker Dean Plocher held a news conference demanding the Senate do what the House has done several times – pass the proposal to require a majority vote in five of the state’s eight congressional districts as well as a statewide majority to approve constitutional amendments.

“This is not our problem,” Plocher said. “This is not our mess.”

With no chance of an August ballot measure to alter the majority requirements, and an initiative petition legalizing abortion undergoing signature checks, the result could be the GOP’s worst fear – that all the restrictive legislation passed over the past two decades of Republican legislative control could be undone.

If abortion gets on the ballot and wins, the Senate is to blame, Plocher said.

“The burden of abortion falls squarely on the Senate and its leadership,” Plocher said.

Senate President Pro Tem Caleb Rowden rejected that statement, saying the House could vote to place the initiative petition measure on the ballot before the legislature adjourns if it so chooses. 

The election on abortion isn’t lost yet, he said

“The notion that (initiative petition) reform being on the ballot is the magic bullet to make sure that the abortion (initiative) doesn’t pass is ridiculous,” Rowden said. “It’s going to take Republicans and conservatives and folks who disagreed on IP to get out to the ballot and vote against that thing in November.”

One reason the measure failed is unwavering opposition by Democrats to provisions added to the bill that would bar non-citizens from voting on constitutional amendments, something that hasn’t been allowed in Missouri since 1924, as well as banning foreign governments or political parties from sponsoring or spending in support of initiatives.

Democrats filibustered for 21 hours in February before the sponsor, state Sen. Mary Elizabeth Coleman, an Arnold Republican, agreed to remove those provisions, derided by opponents as “ballot candy” intended to entice voters with issues unrelated to how majorities are determined.

When the bill was before a House committee, Coleman urged them to reinstate the provisions and the House did so before returning the bill.

That triggered the longest filibuster in state history, with Democrats holding the floor for 50 hours this week to block the measure from a final vote. It ended only when Coleman agreed to ask the House to remove those provisions or engage in negotiations.

“Republicans wanted to make it harder to amend the constitution,” Senate Minority Leader John Rizzo of Independence said at a news conference. “We recognize they have a supermajority, but we won’t let them trick people.”

The issue isn’t dead, said House Majority Leader Jon Patterson of Lee’s Summit and presumptive speaker when the new legislature meets in January.

Patterson thinks the urgency to change the majority threshold will remain.

“The House has stood firm that we believe in life, that we believe in constitutional (initiative petition) reform,” Patterson said.  

It was clear Plocher at least partially blamed the Freedom Caucus – six Senators when the session began but five when it ended because of disagreements over tactics – for the failure of the proposal changing majorities.

“Reading books on the floor does not solve Missouri’s problems,” Plocher said. 

The Freedom Caucus had the record for a filibuster – 41 hours – for two weeks after members held the floor demanding that the proposal on constitutional majorities be brought to an immediate vote. Members spent much of that time reading books about religion and other subjects.

The 41-hour filibuster ended only when Freedom Caucus members were assured every means to pass the proposal – including a rarely used motion to cut off debate – had a majority of 18 votes, said state Sen. Denny Hoskins, a Warrensburg Republican. 

“We would not have sat down two weeks ago on (Medicaid provider taxes) if we were confident that we had a deal done,” Hoskins said.

Throughout the debate on the measure changing initiative petition majorities, Republicans have cited recently approved initiatives on legislative redistricting, expanding Medicaid eligibility and legalizing recreational marijuana as examples of an abuse of the initiative process. The proposals were funded in large part by money from outside the state.

“I don’t believe,” Plocher said, “you should be able to buy your way into Missouri and pass laws.”

Rowden, however, said the idea that ballot candy is needed for changes to the majority threshold to pass is “a slap in the face to Missouri voters. Missourians are absolutely smarter than the people in this chamber give them credit for. “

Sen. Rick Brattin of Harrisonville, speaking for the Freedom Caucus at a news conference, defended the ballot candy provisions as giving voters a simpler question, easier to understand than changing the majority as a standalone issue.

“You would have to have a lot of intensive funding to be able to get a message out, because (the initiative petition process) is a very convoluted, difficult thing to explain to voters,” Brattin said. “And we wanted to make sure we’re putting stuff in front of people that’s easy, that doesn’t require $60 million to try to get the message out.”

Jason Hancock of The Independent staff contributed to this report.

This article has been updated to delete an erroneous reference to ballot language.

Sen. Mike Moon, R-Ash Grove, protests May 16 as the Senate adjourns for the day. (Annelise Hanshaw/Missouri Independent)

The Missouri Senate did nothing but fight during two brief floor sessions Thursday, with Majority Leader Cindy O’Laughlin stepping in during each to cut off acrimonious exchanges, first with a recess and then with adjournment.

As a result, the Senate considered no legislation on the penultimate day of this year’s session and seems unlikely to find a peaceful way to accomplish anything before they must go home at 6 p.m. Friday.

That leaves only a narrow path for what Republicans call their No. 1 priority for the year – changing the threshold for passing constitutional amendments. Senate Democrats filibustered a final vote on the measure for 50 hours this week before the sponsor, state Sen. Mary Elizabeth Coleman, abandoned the attempt. 

Thursday afternoon, the House took up Coleman’s request that it remove items added to the proposal or negotiate over the differences, with the House sponsor, GOP state Rep. Alex Riley of Springfield, asking the House to reject it.

Instead, Riley won a 104-45 party-line vote refusing negotiations and asking the Senate to pass the proposal as it was approved in the House. Because the House had not acted and the Senate adjourned for the day, senators cannot be appointed to negotiate until Friday, too late under the House rules for any conference committee report to come to a vote.

The proposal would change the way votes are counted on constitutional amendments, which currently need only a statewide majority to pass. Under the measure, if approved by voters, that would change by adding a requirement that proposed amendments also win a majority vote in five of the state’s eight congressional districts.

A Democratic filibuster in February stripped Coleman’s proposal down to just the provisions changing the majority threshold. The House revived items removed during the filibuster to bar non-citizens from voting on state constitutional amendments and to outlaw donations or other actions in support of ballot measures by foreign governments and political parties.

During House debate Thursday, Riley acknowledged there is no time for negotiations.

“We put months into this to craft a package that can pass and at this point I stand by that package and I ask the House to join me in that,” Riley said.

State Rep. Barbara Phifer, a Kirkwood Democrat, challenged the provision on non-citizen voting. 

For 100 years, Missouri has barred non-citizens from voting. A constitutional amendment passed by voters in 1924 took away a right that had been in place since 1865 for males who had declared their intent to become citizens.

Riley said there is “a lot of ambiguity” around noncitizen voting. 

“You absolutely don’t have any proof whatsoever,” Phifer said. “It seems to me that the whole thing’s pretty unserious.”

‘Clown show’

The Senate’s morning session became chaotic when state Sen. Bill Eigel of Weldon Spring, a leader of the Missouri Freedom Caucus faction, sought to amend the daily journal to brand his GOP opponents as betrayers of their party.

Referring to Thursday’s vote to ask the House for a conference, Eigel offered an amendment to state that just before the action, “the Senate was interrupted by a stampeding herd of rhinoceroses running through the Senate chamber, laying waste to the institution.”

Hard-right conservatives call more moderate members RINOS, or Republicans in Name Only.

O’Laughlin immediately asked for a recess.

When members returned about 2:30 p.m., Eigel withdrew his amendment and it was GOP state Sen. Mike Cierpiot’s turn. 

His proposal to amend the journal drew blood with a direct attack on three members of the Freedom Caucus being sued by Denton Loudermill for defamation for social media posts tying Loudermill to the shootings at the Kansas City Chiefs championship victory parade. Missouri Attorney General Andrew Bailey is providing legal defense for state Sens. Nick Schroer of Defiance, Rick Brattin of Harrisonville and Denny Hoskins of Warrensburg.

Cierpiot, of Lee’s Summit, wanted the journal to read that “it is the opinion of the Missouri Senate that the office of the attorney general should not expend any money from the state legal expense fund” to defend Hoskins, Schroer and Brattin.

The explosion that followed is why O’Laughlin stepped in to adjourn.

Sen. Mike Moon was defeated on a motion to table Cierpiot’s amendment, then Eigel jumped to his feet. He said the warring factions had acceded to a ceasefire in order to adjourn the Senate for the final time this session, understanding that little else could be accomplished.

“I thought we were gonna come out here and peacefully adjourn but then there’s got to be another shot by” Cierpiot, Eigel said.

Instead, Eigel said, the personal attacks continue.

“I’m sure he’s got a lot of folks that are going to maybe try to drive this amendment through hatred, because that’s what we’ve actually seen this chamber operate on,” he said.

Eigel was about three minutes into his speech when O’Laughlin made the motion to adjourn. That brought an objection from Moon, who was ignored as the vote was taken. He was left shouting, after the microphones were turned off.

“This is an affront to our rules,” Moon said. “It should not happen.”

Cierpiot was unapologetic for his proposal. The Senate has been an embarrassment because of the Freedom Caucus and taxpayers should not pay for their courtroom defense, he said.

“It’s embarrassing,” Cierpiot told The Independent. “The Freedom Caucus has made it a clown show and with the rules we have, if people are dedicated to be part of a clown show it is hard to shut it down.”

Eigel, in an interview with The Independent, said the venomous floor sessions showed the true personality of the Senate.

“The Senate’s demonstrated once again,” Eigel said, “that it is being driven by petty politics and personal vendettas.”

Jason Hancock of The Independent staff contributed to this report.

State Sen. Rick Brattin, a member of the Freedom Caucus, shouts at his Republican colleagues Wednesday during debate on initiative petition changes (Anna Spoerre/Missouri Independent).

A 50-hour Democratic filibuster forced the Senate’s divided GOP majority to finally yield Wednesday evening, stalling a vote on a bill seeking to make it more difficult to amend Missouri’s constitution.

Democrats have blocked all action in the Senate since Monday afternoon, demanding that the legislation be stripped of “ballot candy” that would bar non-citizens from voting and ban foreign entities from contributing to or sponsoring constitutional amendments, both of which are already illegal. 

The Senate passed the bill without ballot candy in February. The House added it back last month.

Senate Minority Leader John Rizzo, an Independence Democrat, on Tuesday said the situation presented an existential crisis for the Senate, as Republicans openly considered a rarely-used maneuver to kill the filibuster and force a vote on the bill. 

“Are the bullies going to win?” Rizzo asked. “Or is the rest of the Senate finally going to stand up for itself and say ‘no more.’” 

He got an answer just before 4:30 p.m. Wednesday, when state Sen. Mary Elizabeth Coleman, an Arnold Republican and the bill’s sponsor, surprised many of her colleagues by asking that the Senate send the bill back to the House for more negotiations on whether to include “ballot candy.” 

Republicans simply didn’t have the votes to kill the filibuster, she said, and Democrats showed no signs of relenting before session ends at 6 p.m. Friday. 

“These policies are too important to play political games with,” Coleman said, adding that going to conference to work out a deal with the House was the only way to keep it alive in the face of unrelenting Democratic opposition. “In a perfect world, we would not be between a rock and a hard place.”

The sudden change in tactics was not well-taken by members of the Freedom Caucus, who argued sending the bill back to the House with only two days left before adjournment puts its chances at risk. 

Tim Jones, a former Missouri House speaker and current director of the state’s Freedom Caucus, wrote on social media Thursday evening that Coleman “effectively killed her own bill today.”

Ultimately, the Senate voted 18-13 to send the bill to conference, with nine Republicans joining nine Democrats in support of the move.

If the bill passes, Missourians would have the opportunity to vote later this year on whether or not to require constitutional amendments be approved by both a majority of votes statewide and a majority of votes in five of the state’s eight congressional districts. 

Right now, amendments pass with a simple majority.

A possible vote on abortion in November is a catalyst behind the battle over the bill, as a campaign to legalize abortion up to the point of fetal viability is on the path to the statewide ballot. 

Republicans have said that without raising the threshold for changing the state’s constitution, a constitutional right to abortion will likely become the law of the land in Missouri. 

State Sen. Rick Brattin, a Harrisonville Republican and a member of the Freedom Caucus, tipped his hat to the Democrats’ “wherewithal” before scorning some of his Republican colleagues. 

“Unfortunately, this Republican Party has no backbone to fight for what is right for life,” he shouted from the Senate floor. “ … They will have the blood of the innocent on their heads. Shame on this party.”

Coleman’s move also came as a surprise to state Rep. Alex Riley, a Republican from Springfield who sponsored the initiative petition bill in the House. 

“We’re going to have to have some conversations tonight to figure out what exactly it is they have in mind,” he said. “We will be having many conversations over the next few hours.”

House Speaker Dean Plocher said he was pleased to see the impasse broken, adding that the House is ready to work on a final version that can be passed. 

He didn’t promise to remove the “ballot candy” added by the House. 

Fate of ‘game changer’ women’s health care bill in hands of Missouri Senate

Asked if Coleman made a tactical mistake in telling the House to restore the items removed during the first Democratic filibuster, Plocher said he hadn’t spoken to Coleman and declined to speculate on whether the outcome would have been different had she not.

Democrats left the Senate Wednesday evening hopeful they will ultimately get their way.

“This body by and large is a staunch supporter of democracy. That doesn’t just go for one side of the aisle. That goes for both sides,” Rizzo said. “This is not protecting the ballot for Democrats or Republicans or one issue or the other issue that you might like or dislike. This protects the ballot box for Republicans and Democrats alike for the future.”

Rizzo maintained that removing the ballot candy is still the only way Democrats will allow the bill to get through the Senate if it returns from the House. 

“If you haven’t figured that out in the last three or four days, I don’t know where you’ve been,” Rizzo said, adding: “Hopefully sleeping.” 

As the Senate prepared to vote, state Sen. Bill Eigel, a Weldon Spring Republican and Freedom Caucus member, warned his colleagues not to be optimistic that the Senate will come back Thursday and pass other bills waiting in the pipeline.

“If the hope is that this process is going to somehow lead us back to a place of engaging more legislation besides this, I’m gonna say this very clearly,” he said. “Don’t get your hopes up.”

Senate Minority Leader John Rizzo, D-Independence, speaks about the second week of the legislative session in a press conference on Jan. 11, 2024 (Annelise Hanshaw/Missouri Independent).

A filibuster in the Missouri Senate set a new record Wednesday morning, as Democrats continued to demand “ballot candy” about non-citizen voting and foreign fundraising be removed from an initiative petition bill before it goes to voters.

The previous modern record for longest filibuster was set earlier this year by the Senate Freedom Caucus, who held the floor for 41 hours. Democrats passed that mark at around 7:30 a.m. Wednesday.

With time ticking down as the legislature is set to adjourn at 6 p.m. Friday, Democrats argue that if Republicans are truly concerned with ensuring only citizens can vote in Missouri elections, there are at least two other bills close to the finish line that include that language.

The GOP could pass those bills, strip the ballot candy out of the initiative petition bill, end the filibuster and allow the Senate to function in its final days, said Senate Minority Leader John Rizzo of Independence.

“We’re more than happy to let that through,” he said.

The longest filibuster in Missouri Senate history happened earlier this year, when the Freedom Caucus held the floor for 41 hours. Democrats will pass that mark around 7:30 a.m.

The bill that inspired this week’s filibuster would ask voters to make it harder to amend the Missouri Constitution through the initiative petition process. But it also includes proposals that would bar non-citizens from voting and ban foreign entities from contributing to or sponsoring constitutional amendments, both of which are already illegal.

Democrats say they will not allow the bill to move forward with even an iota of ballot candy.

“They’re trying to disenfranchise not Democratic voters or Republican voters,” state Sen. Brian Williams, a Democrat from University City, said Tuesday. “They’re trying to disenfranchise Missouri voters.”

The non-citizen voting prohibitions are also included in two bills that would amend the Missouri Constitution to ban ranked-choice voting.

The House passed its version of the ranked-choice voting bill in April, though it hasn’t been heard by a Senate committee.

The Senate also passed its version in April. A House committee approved the bill without making any changes, meaning it could be taken up and sent directly to the statewide ballot at any time this week.

The Senate sponsor of the ranked-choice voting measure, GOP Sen. Ben Brown of Washington, couldn’t be reached for comment. 

But Republicans remain steadfast as of Tuesday afternoon that they want the initiative petition proposal to go to voters with the ballot candy included.

“We want to put something that Republican voters want to vote for,” said Sen. Andrew Koenig, a Manchester Republican and member of the Senate Freedom Caucus. “I think it can look in different ways; however, we don’t want to send this bill to conference. It’s hard to say exactly what’s going to happen, but we’re very limited on what we can do.”

If a compromise can’t be reached, Republicans have one tool at their disposal to end the filibuster: invoking a rarely-used procedural tactic called moving the “previous question.” This immediately ends debate and forces a vote, but Republicans know doing so could have long-term consequences on how the Senate functions.

Moving the “previous question” is still on the table, Koenig said, but it remains a last resort.

Not all Republicans are looking for a showdown over the initiative petition bill. 

Asked Tuesday if he feels any personal urgency to pass the bill, state Sen. Justin Brown, a Rolla Republican, said: “I don’t.”

Senate Democrats have argued invoking the previous question would be an outrage, as  they’ve worked in good faith with Republicans all session — including ending a filibuster of the initiative petition bill earlier this year after ballot candy was removed.

It would be especially outrageous, Democrats contend, because the Senate Freedom Caucus has used the filibuster and other procedural maneuvers to undermine GOP leadership in the chamber and cause gridlock.

A month after Senate Democrats ended a 21-hour filibuster when Republicans agreed to a paired down initiative petition bill, the bill’s sponsor, state Sen. Mary Elizabeth Coleman of Arnold, asked a House committee to put the ballot candy back in.

Senate Democrats said they’d been double crossed, so they retaliated by shutting down Senate business for the day.

Rizzo said if the Republicans invoke the previous question, the consequences could last into next session. While he is not returning to the chamber in 2025, Rizzo said Democrats should play by the Freedom Caucus’s rules next year.

“I would definitely try to do everything I could to be the most disruptive,” Rizzo said during his second filibuster shift Tuesday morning. “ … Because there is no reason to go to work if you’re not getting the stuff you want or work in good faith because it’s clearly not rewarded.”

Fate of ‘game changer’ women’s health care bill in hands of Missouri Senate

The Senate gridlock stems from the likelihood that Missouri voters will have the chance to vote to re-establish the constitutional right to abortion later this year. A campaign to legalize abortion up to the point of fetal viability in recently submitted more than 380,000 signatures to the Missouri Secretary of State’s office, paving the way for the issue to land on the November ballot.

Republicans hope that by raising the threshold needed to pass citizen-led ballot measures, they will be able to defeat the abortion vote. 

In a video posted to social media Tuesday, state Sen. Bill Eigel, a Republican from Weldon Spring, said he’d been up all night “defending liberty.”

“We’re going to make (the Democrats) continue to talk until they’re ready to see initiative petition reform go to the people of this state,” Eigel said. “And we’re going to protect our Constitution. We’re going to protect it from the abortionists who want to enshrine a culture of death into the founding document of the state.”

The Independent’s Rudi Keller contributed to this story. 

Sen. Lauren Arthur of Kansas City speaks during a 2023 debate in the Missouri Senate (photo courtesy of Senate Communications).

A Democratic filibuster of legislation making it harder for Missourians to amend the state constitution through citizen-led initiatives stretched through the night and into its 15th hour Tuesday morning. 

Though Democrats oppose the changes to the initiative petition process, their filibuster was focused on GOP efforts to include “ballot candy” that would add unrelated issues about immigrants voting and foreign fundraising to the question that would appear on the statewide ballot. 

Unless Republicans agree to ditch all of the ballot candy — which was removed when the Senate originally passed the bill in March — Democrats have vowed to block all action in the Senate until the legislative session adjourns at 6 p.m. Friday. 

“Since it is forever,” state Sen. Lauren Arthur, a Kansas City Democrat, said of the amendment. “This is worth fighting and trying to stop.” 

Republicans show no signs of backing down on the ballot candy, raising the odds that the Senate will be unable to pass anything else before adjourning.

“There is a hope that we are able to find a resolution to move forward so that the rest of session is able to operate,” state Sen. Mary Elizabeth Coleman, a Republican from Arnold sponsoring the initiative petition bill.

If the bill clears the legislature, it would go on the statewide ballot, most likely in August. 

Missourians would be asked whether they want to require constitutional amendments be approved by both a majority of votes statewide and a majority of votes in a majority of the state’s eight congressional districts.

Currently, amendments pass with a simple majority.

Republicans have pushed to change the initiative petition process for years, but the effort picked up steam more recently as a campaign to restore abortion access in Missouri advanced closer to appearing on the ballot. 

These lawmakers on the right have said that without eliminating the simple majority, abortion would likely become legal again. Missouri was the first state to outlaw abortion in nearly every circumstance in June 2022 after Roe v. Wade was overturned. 

Democrats say the initiative petition process gives voice to citizens when elected officials aren’t acting on the will of the people.

“There must be some serious concerns that this isn’t the will of the people – the majority of the folks in the state of Missouri want autonomy over their bodies,” said state Sen. Steve Roberts, a St. Louis Democrat. “Otherwise why would you lead a misguided effort to confuse voters to make it more difficult to have their voices heard?”

Threat of the previous question

In addition to the changes to the initiative petition process, the bill being blocked in the Senate would ask Missourians if they want to bar non-citizens from voting and ban foreign entities from contributing to or sponsoring constitutional amendments. 

Non-citizens have been barred from voting in Missouri since 1924. Federal law already bans foreign entities from getting involved.

Arthur said these “are not real threats,” but rather “scary hypotheticals.”

During Senate debate Monday, Democratic state Sen. John Rizzo of Independence said he’s been approached by Republicans trying to negotiate to take some, but not all, of the ballot candy. 

“No,” Rizzo said he told them. “I’m not deceiving voters just a little bit.”Arthur replied that Democrats will only end the filibuster if the ballot candy is completely removed, or if they’re forced to through a “previous question,” a rarely-used procedural maneuver to cut off a filibuster and force a vote on a bill.

The previous question is considered a last resort in the Senate because the response is typically total gridlock as Democrats would use the chamber’s rules to derail the rest of the legislative session. 

During a television interview broadcast Sunday, Senate Majority Leader Cindy O’Laughlin referred to the previous question motion as the “nuclear” option, saying she hasn’t made a decision yet whether to use it to pass initiative petition legislation or not. 

But last week, state Sen. Rick Brattin, a Harrisonville Republican and a member of the Missouri Freedom Caucus, said his party is ready to use “any means necessary” to pass the initiative petition bill.

Republicans have said the change is necessary, arguing Missouri’s constitution is too easy to change, and that passing this amendment would give more voice to rural voters. Democrats say the bill is an attack on the concept of “one person, one vote.”

Senate Democrats on Monday continued to argue that such a constitutional change would make it virtually impossible for citizen-led ballot measures to ever be successful. 

A February analysis by The Independent found that under the concurrent majority standard being proposed by Republicans, as few as 23% of voters could defeat a ballot measure. This was done by looking at the majority in the four districts with the fewest number of voters in 2020 and 2022.

State Sen. Tracy McCreery, an Olivette Democrat, cited this story on Monday afternoon, saying that this outcome “should raise alarms.”

“It will make politicians even more powerful,” McCreery said. “It takes power away from the people and puts way more power into the hands of politicians.”

At about 4 a.m., Rizzo took the floor again for his second filibuster shift this week.

“I don’t see the end in sight any time soon,” he said.

“Unfortunately we have to be here in the last week of session as bills are dying minute by minute, and lobbyists are probably running around somewhere here in a few hours screaming and yelling about why their bills are dying,” Rizzo said. “Because they can’t live without ballot candy.”

Missouri Gov. Mike Parson begins the annual State of the State speech to a joint session of the legislature on Wednesday with House Speaker Dean Plocher and Lt. Gov. Mike Kehoe beside him (Annelise Hanshaw/Missouri Independent).

For the second year in a row, the fate of a bill creating new child care tax credits — one of Gov. Mike Parson’s top legislative priorities — is in the hands of a faction of Republicans in the Missouri Senate. 

Designed to help improve access and affordability of child care, the package of child care tax credits has received bipartisan support and was the first bill approved by the House this year. 

But that bill, sponsored by Republican state Rep. Brenda Shields of St. Joseph, stalled in the Senate. Democratic state Sen. Lauren Arthur’s version of the legislation hasn’t fared any better. 

With the legislative session ending at 6 p.m. Friday, and gridlock expected in the Senate, the odds of the bill making it to the governor’s desk are slim. 

A similar dynamic killed the legislation last year. 

“Hope remains,” Arthur said Friday. “But things are still up in the air.” 

The governor has pushed the legislation as a way to help parents in the workforce, highlighting the proposal in his last two State of the State addresses to the legislature. The legislation has also gained support from child advocacy organizations, chambers of commerce and business groups, and received little opposition in committee hearings this year. 

Casey Hanson, director of outreach and engagement at the child advocacy nonprofit Kids Win Missouri, which has advocated in support of the legislation, said she’s trying to stay optimistic. 

But this session, Hanson said, is looking increasingly like 2023.

“Same roadblocks. Same characters,” she said. “Different year.”

‘It’s welfare’

A proposal by Arthur to add the child care tax credits bill onto another bill as an amendment was shut down by the Missouri Freedom Caucus last week.

State Sen. Bill Eigel, a Republican from Weldon Spring who is running for governor, characterized Parson’s child care priorities as promoting a larger government and making it “a great time to be a Democrat in Jefferson City.”

“…And it’s not to actually protect the rights of the children. In this case it’s to give them something,” Eigel continued. “In this case it’s, well, we want to give away free child care.”

State Sen. Rick Brattin, a Harrisonville Republican and a member of the Freedom Caucus, also spoke in opposition to the proposal, saying “government created all the regulations that literally decimated the child care industry” and now government is trying to “swoop in” to fix a problem it caused.

State Sen. Mike Moon, a Republican from Ash Grove, later piled on.

“I think it is welfare,” Moon said, adding that he and his wife decided she would stay home with their children years ago. “We should be establishing an environment so our families can take care of themselves and their children on their own dime.”

Eigel has alluded to a potential compromise between the Freedom Caucus and the sponsors of the child care tax credits legislation. Arthur said she has been in ongoing conversations with him about finding a compromise between his desire for personal property tax cuts and her child care tax credits. 

But she admitted their idea of a reasonable middle ground will likely be very different.

“I’m frustrated that I have to defend legislation that working families are desperate for,” Arthur said. “Meanwhile my male colleagues get on the floor and decry the idea that government is going to play any role in trying to make child care more affordable and available.” 

But the likeliest roadblock to the legislation finally heading to the governor’s desk is a Senate bill hoping to make it more difficult to amend the state’s constitution by way of citizen-led initiative petition. 

That top priority for Republicans is likely to cause strife between parties in the last week of session, potentially halting any other legislation from moving forward. 

Democrats have vowed to filibuster the legislation as Republicans threaten to invoke an unpopular and rarely-used tactic called moving the “previous question” to force a vote on the bill. 

If Republicans do that, Arthur said Friday, “ultimately they’re deciding that nothing else is going to get done.”

‘I can’t find care’

As the Senate runs up against the session deadline, emails supporting her child care tax credits bill continue to pour into Shields’ inbox.  

“It’s not affordable for me to go to work,” some say. Others send pleas: “I can’t find care.”

Those who have been able to find affordable child care lament that the quality of care isn’t up to their standards. Other Missourians relayed stories of their child care provider closing their doors with less than 30 days notice, leaving them scrambling to find a new provider.

Shields often cites a 2021 U.S. Chamber of Commerce Foundation study that found lack of accessible and quality child care forced many Missouri parents to change or leave their workplace. The foundation determined this workforce disruption cost the state more than $1.3 billion annually. 

She feels for those families. Thirty-five years ago, Shields said, she faced a similar choice between her career and being a mother. She wanted both, and, thanks to a last-minute child care opening in St. Joseph, she got both. 

An investigation of child care spending by The Independent and MuckRock last year found that almost half of Missouri’s children under age five, or about 202,000 children, live in child care deserts, with one or fewer child care openings for every three children. 

The average cost of full-time center-based care for an infant in Missouri was $11,059 as of 2022, according to Child Care Aware. Meanwhile staff at child care facilities often make just over minimum wage, presenting a challenge to hiring and retention. 

“If we want to grow our economy,” Shields told The Independent on Wednesday. “It requires us to help people get back to work.”

Her bill would add three tax credits: 

• The “Child Care Contribution” tax credit would let those who donate to child care providers receive a credit equal to 75% of their donation, up to $200,000 in tax credits. 
• The “Employer Provided Child Care Assistance” would encourage partnerships between businesses whose employees need child care and providers by allowing employers to receive tax credits equivalent to 30% of qualifying child care expenditures. 
• The “Child Care Providers Tax Credit” would allow child care providers to claim a tax credit equal to the provider’s employer withholding tax and up to 30% of a provider’s capital expenditures on costs like expanding or renovating their facilities. 

Kids Win Missouri recently embarked on a community project highlighting child care needs in several counties across the state. This included Shields’ hometown of St. Joseph.

There, in surveying community members and providers, they found that there are only enough child care slots available for 29% of infants and toddlers, and 69% of pre-kindergarteners and 53% of other preschoolers. Families in the county, on average, put at least 20% of their income toward child care costs. 

To survive this “massive societal crisis,” said Hanson, with Kids Win Missouri, it will take everyone, especially as the state approaches a fiscal cliff leaving it without the same levels of COVID-era federal funding in place now.

Child care subsidies 

Parson’s push to expand access to child care also included higher payments for subsidized care. To fund it, Parson asked lawmakers for an extra $51.7 million in the coming year, which followed a $78 million boost to funding in the current year.

Ultimately, the increase was funded, but not in the way the governor requested.

The budget includes language authorizing increased rates, House Budget Committee Chairman Cody Smith said in a news conference after the budget was passed.

The additional funding sought by Parson was based on every eligible parent using their benefits, Smith said. Instead, the budget allows higher rates by assuming that some money would otherwise be unspent.

If demand for the subsidy increases, lawmakers will have to return to the table to discuss ways to continue funding the increase in the future.

House Minority Leader Crystal Quade said Democrats are still trying to calculate whether there are funding shortfalls.

Quade said despite child care being a persistent issue, the legislature failed to address the shortage in a meaningful way.

“We know there are too many Republicans in positions of power in this state who do not believe that I have a voice in this room, that I should not be elected, standing here as a mother, and I should be at home,” Quade said. “And I’m tired of them telling us that.”

The Independent’s Rudi Keller contributed.

Senate Majority Leader Cindy O'Laughlin of Shelbina speaks Thursday evening after passage of a $51.7 billion state budget as Sen. Lincoln Hough of Springfield waits for his turn to speak (Rudi Keller/Missouri Independent).

With the state budget finally out of the way, Missouri Republicans are ready to turn their attention to a priority they’ve pursued since day one of legislative session: making it harder to amend the state constitution through an initiative petition.

Senate Majority Leader Cindy O’Laughlin told reporters Thursday that Republicans intend to bring the initiative petition bill to the floor at noon Monday, five days before the end of session. However, the Senate on Friday afternoon announced they wouldn’t reconvene until 2 p.m. Monday.

State Sen. Andrew Koenig of Manchester, a member of the Missouri Freedom Caucus, said Republicans plan to put changes to the initiative petition process before voters this year, even if it means invoking a rarely-used process to quash a Democratic filibuster.

The proposal would require constitutional amendments placed on the ballot through the initiative petition process to pass by both a simple majority of votes statewide and a majority of votes in at least a majority of the votes in Missouri’s congressional districts.

State Sen. Rick Brattin, a Harrisonville Republican and Freedom Caucus member, said Republicans are ready to use “any means necessary” to pass the initiative petition bill. 

Republicans have argued that Missouri’s constitution is too easy to change, and that passing this amendment would give more voice to rural voters. Fueling their concerns this year is a proposed initiative petition seeking to get on the November ballot that would enshrine abortion rights into the constitution.  

Democrats counter that the change is a direct assault on the concept of “one person, one vote” making it practically impossible for citizen-led ballot measures  — which are already costly endeavors — to ever be victorious. 

Initiative petitions campaigns currently require signatures from 8% of voters in six of the state’s eight congressional districts to qualify for the ballot. To pass once on the ballot, a statewide vote of 50% plus one is required — a simple majority vote.

An analysis by The Independent found that under the concurrent majority standard being proposed by Republicans, as few as 23% of voters could defeat a ballot measure. This was done by looking at the majority in the four districts with the fewest number of voters in 2020 and 2022.

Senate Minority Leader John Rizzo, an Independence Democrat, said Thursday that his party has  worked in good faith on plenty of bills they opposed this session. And they are ready to sit down and let the initiative petition bill pass and be placed on the August ballot if Republicans remove the “ballot candy,” referring to provisions added that are unrelated to initiative petitions but included to make the proposal more appealing to conservative voters.  

Alongside the initiative petition changes, the GOP-backed bill would ask Missourians to change the constitution to define legal voters as citizens of the United States as well as whether they want to prohibit foreign entities from sponsoring initiative petitions. 

“They know if they have a straight-up fight over this issue, they lose,” Rizzo said. “Which is why they have to contort themselves into all these different shapes and sizes in order to fool people into voting for something that will take rights away from them.” 

Koenig said there are three paths forward for Republicans: session ends without a vote on the bill, Democrats relent and allow a vote with ballot candy, or Republicans break the Democratic filibuster and force a vote.

In the Missouri Senate, with a long tradition of unlimited debate, moving to kill a filibuster is rare and typically results in a quick end to the legislative session. 

The bill got initial approval from the Senate in February following a 21-hour-long filibuster by Democrats who only agreed to sit down once the “ballot candy” was removed. 

A day later while sitting before the House Committee on Elections and Elected Officials, state Sen. Mary Elizabeth Coleman, the bill’s sponsor, asked the House to reinstate the ballot candy, adding that Senate Republicans would be willing to kill a filibuster in order to defeat another filibuster by Democrats down the road. 

Democrats cried foul, saying Coleman’s push represented a double cross after a deal was struck in the Senate. Nevertheless, the House ultimately obliged Coleman, passing the measure with ballot candy attached back to the Senate.

Missouri Senate avoids impasse over budget to make constitutional deadline

On Thursday, after the passage of the state budget, Coleman brought her bill to the floor for final passage. But after about 20 minutes of debate, she withdrew the bill for the day. 

Brattin said his caucus colleagues agreed to end their 41-hour filibuster last week as part of an agreement to get both the budget and initiative petition changes across the finish line.

Republicans, Brattin said, are ready to use “any means necessary” to pass the initiative petition bill. 

Speaking to reporters Thursday, O’Laughlin gave no indication about whether she was considering a move to cut off debate and force a vote on the bill.

Rizzo acknowledged that Senate Democrats will be “throwing caution to the wind” if they take up a filibuster, but said they’ve been left with no other option to try and protect citizens’ voices.

In the past two election cycles, two ballot measures stemming from initiative petitions – Medicaid expansion and recreational marijuana legalization – have passed despite opposition from the GOP majority in the statehouse. Meanwhile, hundreds of other initiative petition campaigns failed to land on the ballot in the first place.   

Just last week, four initiative petition campaigns turned in signatures to the Missouri Secretary of State’s office hoping to land a spot on the ballot. Perhaps chief among these is a measure that would legalize abortion up to the point of fetal viability in Missouri, where nearly all abortions are illegal. 

Republican leaders since last year have said that if the initiative petition process doesn’t change, abortion would likely become legal again in Missouri. 

“Instead of the legislature being happy they don’t have to deal with the issue,” Rizzo said Thursday. “They’re offended that the people would have the audacity to go around them.”

This story was updated at 2:45 p.m. Friday to reflect when the Senate plans to reconvene on Monday.

The Independent’s Rudi Keller contributed.

The exterior of Planned Parenthood Reproductive Health Services Center is seen on May 31, 2019 in St. Louis (Photo by Michael Thomas/Getty Images).

Missouri’s Planned Parenthood clinics say they will continue serving patients on Medicaid, even after Gov. Mike Parson signed legislation Thursday blocking state and federal funds from going to the organization. 

The new law, which goes into effect Aug. 28, is the third — and Republicans hope final — attempt to end Medicaid reimbursements to any health centers affiliated with abortion providers. 

Despite this, Planned Parenthood announced Thursday its clinics will remain “open to all.” 

Planned Parenthood clinics in Missouri no longer perform abortions; their affiliates in Illinois and Kansas do. In Missouri, clinics continue to provide services such as contraceptive care, STI testing, cancer screenings and wellness checks.

“Experts have been clear there are not enough providers in the system to absorb the thousands of patients that Planned Parenthood health centers serve,” Planned Parenthood Great Plains and Planned Parenthood St. Louis Region and Southwest Missouri said in a joint statement Thursday.

Parson was flanked by Republican state Rep. Cody Smith of Carthage and Republican state Sen. Mary Elizabeth Coleman of Arnold as he signed the legislation Thursday morning.

“We’ve ended all elective abortions in this state, approved new support for mothers, expecting mothers and children and, with this bill, ensured that we are not sending taxpayer dollars to abortion providers for any purpose,” Parson said in a statement.

Nearly one in five Planned Parenthood patients in Missouri are insured through MO HealthNet, the state’s Medicaid program that serves low-income and disabled citizens and has long banned funding for abortion. 

Planned Parenthood also sees more than half of Missouri’s low-income patients seeking family planning services, according to the Missouri Family Health Council Inc.

Democrats argued the legislation would primarily harm low-income Missourians who could be forced to find a new provider through the state’s already strained public health safety net if Planned Parenthood cannot foot the bill for these patients long-term. This could delay critical and potentially life-saving care.

In Missouri, women on Medicaid are 10 times more likely to die within one year of pregnancy than those on private insurance, according to an August multi-year report on maternal mortality published by the Missouri Department of Health and Senior Services. 

Missouri is also fighting rising congenital syphilis rates. In the majority of these cases, pregnant mothers had little to no prenatal care, highlighting a larger issue of maternal health care access, the health department noted.

Fate of ‘game changer’ women’s health care bill in hands of Missouri Senate

Through an informal survey, the Missouri Family Health Council Inc. found that over the past two years, the wait list for new patients at public health safety net clinics can be weeks or months, and that’s if the provider is taking new patients at all. Meanwhile, wait times at the state’s Planned Parenthood clinics averaged between the same day and three days to get an appointment. 

“Other providers cannot absorb the thousands of patients impacted by this ‘defunding’ attack,” Planned Parenthood said in a statement. “For this reason, Planned Parenthood health centers have worked to keep serving MO HealthNet patients at no cost though it is an unsustainable model for a state’s health care system.”

Planned Parenthood clinics in Missouri have been without Medicaid reimbursements for more than two years as prior attempts by Republicans to pass similar restrictions through the state budget were litigated and later struck down in court. 

Emily Wales, CEO and president of Planned Parenthood Great Plains, said her organization offset the cost of care for Missouri Medicaid patients during this time through private fundraising. 

Both Planned Parenthood affiliates in Missouri have said they plan to continue seeing patients on Medicaid “no matter what.” They have not elaborated on how they plan to afford to do so. 

Planned Parenthood on Thursday continues to argue that the latest law is also unconstitutional, and is in violation of federal Medicaid law, which states patients have a right to choose their provider.

A similar law that went into effect in Arkansas several years ago was ultimately upheld by the 8th U.S. Circuit Court of Appeals in St. Louis. Planned Parenthood Great Plains, which oversees that state’s clinics, stopped seeing Arkansas Medicaid patients immediately. 

Parson signed the bill near the end of the 15 days he had to do so despite a group of Republican lawmakers attempting to strong-arm him into doing so sooner.

Last month, Senate members of the Missouri Freedom Caucus promised to filibuster the renewal of Medicaid taxes, known as the federal reimbursement allowance, until Parson signed the defund Planned Parenthood bill and until the General Assembly approved a proposed constitutional amendment that would make it more difficult to pass constitutional amendments proposed by voter-led initiatives.

The initiative petition bill and the FRA require a final vote in the Senate before the legislative session ends at 6 p.m. on May 17.

The exterior of a Planned Parenthood Reproductive Health Services Center on May 28, 2019 in St Louis (Michael B. Thomas/Getty Images).

Missouri Gov. Mike Parson on Thursday signed legislation limiting Planned Parenthood’s ability to serve low-income patients at a ceremony in his Capitol office Thursday. 

The new law, which will go into effect Aug. 28, will end Medicaid reimbursements to any health centers affiliated with abortion providers. In Missouri, the law would apply to Planned Parenthood. 

“This is something Republicans have been working for years, since we captured the majority,” said state Sen. Mary Elizabeth Coleman, an Arnold Republican who sponsored a version of the legislation. She added: “It’s a huge victory. Missouri has a long history of being a pro-life state.” 

Nearly every abortion, with exceptions for medical emergencies, has been illegal in Missouri since 2022. However, the state’s Planned Parenthood clinics have continued to operate, providing services such as contraceptive care, STI testing, cancer screenings and wellness checks.

Fate of ‘game changer’ women’s health care bill in hands of Missouri Senate

Missouri Republicans have argued that no additional money should be going to Planned Parenthood, since Missouri’s locations are affiliated with clinics in Kansas and Illinois, where abortion is legal and where many Missourians travel for the procedure.

Democrats, Planned Parenthood and other health institutes have argued that the bill would cause the most harm to Missouri’s most vulnerable population, who may be forced to find a new provider. But the state’s public health safety net is already strained and will have a difficult time absorbing the thousands of displaced patients. 

Two weeks ago, the Missouri House approved the legislation, originally filed by Republican state Rep, Cody Smith of Carthage, though it did so without approving an emergency clause which would have put the bill into effect immediately upon the governor’s signing.

Coleman’s version of the bill was blocked by a Democratic filibuster in February. A second filibuster by Senate Democrats in April was abandoned after 11 hours when Republicans agreed to remove a provision that would have ended contracts with organizations founded by eugenicists.

Missouri Republicans have twice before tried to pass a similar restriction through the state budget, attempts that were ruled unconstitutional by state courts.

A similar restriction went into effect in Arkansas several years ago when the law was upheld by the 8th U.S. Circuit Court of Appeals in St. Louis. At that time, Planned Parenthood clinics in Arkansas immediately stopped seeing Medicaid patients. 

After the bill cleared the legislature, Planned Parenthood Great Plains and Planned Parenthood of St. Louis Region and Southwest Missouri, which have clinics in Missouri, said in a statement that they will continue trying to serve all patients, “no matter what.” 

As of March, Planned Parenthood clinics in Missouri had been without Medicaid reimbursements for two years. At the time, Emily Wales, CEO and president of Planned Parenthood Great Plains, said her organization offset the cost of care for Missouri Medicaid patients through private fundraising. 

MO HealthNet, the state’s Medicaid program, serves low-income and disabled citizens and has long banned funding for abortion, with limited exceptions. 

Planned Parenthood has said nearly one in five of their Missouri patients are on Medicaid.

The Missouri Family Health Council Inc. has been particularly vocal against the bill, saying it could harm thousands of patients.

The health care nonprofit found through informal surveying that across Missouri’s safety net clinics, wait times over the past two years averaged between five and seven weeks, with some clinics as few as two weeks and some pausing new patients completely. Meanwhile, wait times at the state’s Planned Parenthood clinics averaged between the same day and three days to get an appointment. 

In 2022, across all 68 safety net clinics in the state that take Title X funding, around 24% of the clients were on Medicaid, said Michelle Trupiano, the council’s executive director.

The Independent’s Jason Hancock contributed. 

Senate Majority Leader Chuck Schumer announced on Wednesday that the Senate will vote in June on legislation guaranteeing the right to access contraception (Getty Images)

A wide-ranging women’s health care bill that stalled in the House for months over concerns about expanding coverage for birth control is a step away from the governor’s desk — though dysfunction in the Senate could derail its chances of becoming law. 

The bill, an effort by a bipartisan group of five women lawmakers across the House and Senate, would be “a game changer” for women’s health, said state Rep. Melanie Stinnett, a Republican from Springfield.

With provisions focused on annual supply birth control, congenital syphilis, mammograms, STI treatment and rape test kits, the legislation is sponsored by Stinnett; state Sen. Elaine Gannon, a DeSoto Republican; State Rep. Tara Peters, a Rolla Republican; State Sen. Tracy McCreery, an Olivette Democrat; and state Rep. Patty Lewis, a Kansas City Democrat.

“We need to focus on women’s health, children’s health, babies’ health,” Gannon said. “We have to do whatever we can do to produce healthy people.”

Though it got its initial committee hearing in January, the House didn’t pass the bill and send it to the Senate until late April. The delay was caused by a number of Republicans expressing concerns that birth control could be used as an abortifacient, the bill’s sponsors said.

Since passing the House with approval from 60 Republicans and 45 Democrats, it has moved quickly in the Senate and was approved unanimously by the chamber’s emerging issues committee on Monday. 

“This bill was on life support several times as it moved its way forward,” Lewis said. “But no matter what side of the aisle you’re on, it’s politically advantageous to support women’s health care right now.”

The sponsors remain hopeful the bill can make it across the finish line before session ends on May 17.

But progress in the Senate is stalled as infighting between the Freedom Caucus and Senate Republican leadership has left the chamber with little to show as they run up against a deadline to pass the state budget. 

Also hanging in limbo is a bill that would make it more difficult to pass citizen-led constitutional amendments, legislation Democrats have staunchly opposed, fearing it could inhibit an abortion rights proposal expected to land on the November ballot. 

The sponsors of the women’s health care bill argue that unlike other legislation, theirs should not be controversial and thus shouldn’t be a casualty of Senate gridlock. 

“If the supermajority knew how to govern, they could bulldoze anything through,” Lewis said.  “But they are too busy fighting amongst themselves and ultimately playing games with people’s lives.” 

Annual supply birth control

Peters said if there’s one thing she’s learned in her freshman term in the House, it’s that all it takes to mount a campaign to kill a bill is the word “abortion.”

The legislation, which would allow women on private insurance to pick up an annual supply of contraceptives rather than going to the pharmacy every few months, is already law in 26 states. Studies show this increase in access and continuity can help prevent unintended pregnancy. It does not apply to abortifacients.

Stinnett, who has a master’s degree in health care administration and who serves as vice chair of the House Healthcare Reform Committee, said several Republican colleagues had questions about hormonal contraceptives and whether drugs that induce abortions fall under the statute. 

“At every turn we either had to educate or deflate or talk against what wasn’t true,” Peters said, adding that some lawmakers were spreading inaccurate information that the bill had to do with abortion drugs.

After whipping the bill several times, Peters said she ultimately won over the needed support, finally moving the bill out of the House in late April, despite it receiving an initial House committee hearing in January.

Only the Missouri Insurance Coalition and America’s Health Insurance Plans and Blue Cross Blue Shield of Kansas City were present to testify in opposition of the birth control policy.

A recent survey released by The Right Time, a family planning initiative through the Missouri Family Health Council Inc., showed Missourians overwhelmingly support access to contraceptives, but some fear their lawmakers could pass laws limiting that availability.

Of the 1,000 Missourians polled between the ages of 18 and 35, 77% said they believed there should be access to annual supplies of birth control.

“I would have to dig pretty deep to find out when the last proactive sexual and reproductive health care legislation of a ‘women’s health type’ passed,” said Mandy Hagseth, the council’s director of policy and external affairs. “So it does not come often and it does not come easy.”

Hagseth previously told The Independent that in conversations with women around Missouri, the council learned that access to clinics, lack of consistent transportation and balancing work and children are often barriers to picking up their contraception consistently, which can create gaps in use and increase the chances of an unintended pregnancy. 

More than 373,000 Missouri women live in contraceptive deserts, which they define as a place where there’s not reasonable access to a full range of contraceptive methods, according to data compiled by Power to Decide. Most are in rural counties.

“The Senate has an opportunity to pass a really important, pro-active women’s health bill,” Hagseth said. “At a time that it’s woefully needed sort of generally and politically.”

Congenital syphilis testing

In 2022, Missouri recorded 81 congenital syphilis cases — the most in 30 years, the state health department said in an alert distributed earlier this year. 

From 2017 to 2021, congenital syphilis cases rose 219% across the country; in Missouri, they rose 593%, according to the Centers for Disease Control and Prevention. Between 2012 and 2015, one stillbirth from a congenital syphilis case was reported in Missouri. Since then, there’s been at least one infant death every year, with 18 deaths reported between 2016 and 2022, according to the Missouri Department of Health and Senior Services. 

Mothers can pass along congenital syphilis in utero at any point in pregnancy. But if caught before the baby passes through the birth canal, the disease is reversible in the womb.

For adults, the symptoms, if there are any, can include a rash on the palms of a person’s hands or on the soles of their feet, hair loss, swollen lymph nodes or sores. Often these symptoms go away on their own, even though they are still contagious.  If a mother is infected within four weeks of delivering their baby and doesn’t get treatment, the infant has a 40% chance of dying at birth or shortly after, according to the CDC.

Right now, only two syphilis tests are required in pregnancy: one in the first trimester and one at birth. The bill would also require a third trimester test for HIV and hepatitis C and hepatitis B, which can cause liver damage in infants.  

This legislation hopes to address this outbreak by adding additional optional testing for women around 28 weeks of pregnancy during their regularly-scheduled appointment. 

“Anything we can do to ensure that baby is born healthy, that’s what we need to be doing,” Gannon said.

Mammograms, STI treatment and forensic exams

McCreery said after she went in for a mammogram at the start of the year, she received a “weird form letter” that left her thinking she needed additional testing to ensure she didn’t have breast cancer. 

New federal regulations for mammograms are now at odds with Missouri’s statute, so this bill would update the language given to patients after a cancer screening to be less confusing, as the current language may cause unnecessary concern.

“We need to speak in clear, easy to understand terms when we’re communicating with somebody after they’ve had an exam like that,” McCreery said.

The bill also hopes to make treatment easier for trichomoniasis, an infection that’s more common in women then men. 

Under current state statute, if someone is diagnosed with gonorrhea and chlamydia, their doctor is allowed to also treat the patient’s sexual partner in a process called expedited partner therapy. Under this legislation, trichomoniasis would also be added to that list, and it would open the door for syphilis to also be added if federal guidelines change as syphilis rates rise.

The final piece of the legislation would smooth out a law passed in 2022 that requires survivors of rape or sexual assault be given the option to ask for a forensic exam.

Right now, speciality hospitals without emergency departments are not exempt from the statute, meaning survivors can be taken to health care providers without access to rape test kits. This statute would require that patients initially seen at specialty hospitals be transferred to a hospital with an emergency department equipped to do a forensic exam.

Attendees cheer during a Missourians for Constitutional Freedom rally after the campaign turned in more than 380,000 signatures for its initiative petition to enshrine abortion rights in Missouri’s constitution Friday morning (Annelise Hanshaw/Missouri Independent).

A campaign to enshrine abortion rights in Missouri’s constitution said Friday that it collected more than 380,000 signatures in just three months, more than twice the likely total needed to qualify for this year’s statewide ballot. 

The coalition, called Missourians for Constitutional Freedom, is hoping to put on the November ballot a measure that would legalize abortion up to the point of fetal viability. Since June 2022, nearly every abortion has been illegal in the state with the exception of medical emergencies. 

In order to put a citizen-led constitutional amendment before voters, the campaign had to collect signatures from 8% of voters in six of Missouri’s eight congressional districts. That total equates to more than 171,000 signatures. 

The campaign on Friday morning announced they officially turned in 380,159 signatures to the Missouri Secretary of State’s office. A breakdown of how many signatures came from each district, which will ultimately determine if they met the threshold needed to qualify, was not provided. But the coalition said they collected signatures from each of Missouri’s counties and congressional districts.

“Hundreds of thousands of Missourians are now having conversations about abortion and reproductive freedom; some are sharing their own abortion stories for the very first time; and all are ready to do whatever it takes to win at the ballot box this year,” Mallory Schwarz, executive director of Abortion Action Missouri and spokesperson for Missourians for Constitutional Freedom, said in a statement. “Together, we are going to end Missouri’s abortion ban.”  

The effort kicked off 90 days ago, requiring a massive undertaking to reach the May 5 signature deadline. The coalition is led by Abortion Action Missouri, the ACLU of Missouri and Planned Parenthood affiliates in Kansas City and St. Louis.

Like abortion campaigns that have played out in other states, Missouri’s coalition has been able to raise more than $5 million dollars in donations, including from the Sixteen Thirty Fund, a liberal dark money organization based in Washington, D.C., that gave $1 million. Separately, more than 3,200 individual Missourians contributed $1.8 million in the first three months of the year, according to a campaign finance report published last month.

This year, more than 1,800 volunteers from around Missouri helped collect signatures, according to a news release from the coalition. In the three weekends leading up to the deadline, the coalition said volunteers collected 18,000 signatures and knocked on 40,000 doors. 

Dr. Iman Alsaden, chief medical officer for Planned Parenthood Great Plains and advisor to Missourians for Constitutional Freedom, said they became an abortion provider in part to sit with patients and help counter any narrative that they are bad people for having an abortion. But the overturning of Roe v. Wade in 2022 made the job much more difficult.

“Medical decision-making is clouded by unclear and harsh laws that make providers feel scared to do the right thing,” Alsaden said.

The initial attempt to place abortion on the ballot began in March 2023. Legal fights over the ballot language and internal disagreements on whether to include a viability ban stalled signature gathering attempts until January. Viability is often considered to be around 24 weeks of pregnancy.

The initiative petition language the coalition settled on would allow the legislature to “regulate the provision of abortion after fetal viability provided that under no circumstance shall the government deny, interfere with, delay or otherwise restrict an abortion that in the good faith judgment of a treating health care professional is needed to protect the life or physical or mental health of the pregnant person.”

Also among those gathered in front of Missouri’s Capitol to celebrate Friday was Sam Hawickhorst, who in 2015, at 22 years old, had an abortion in Missouri.

“It felt like everyone I reached out to for support made my pregnancy about themselves while I, the pregnant person, was an afterthought,” she told a crowd of about 200 people. “I felt like a burden. But despite these initial hurdles, I knew I had to look out for myself because no one else was.”

After reaching out to a friend who had recently had an abortion, Hawickhorst went to Planned Parenthood where she was prescribed abortion pills. During the multiple appointments and the transvaginal exam then required by state law, Hawickhorst said she felt as if the government was “ensuring cruelty every step of the way” in order for her to have an abortion.

“Abortion is healthcare. Abortion is normal. And those who have had and will have abortions deserve dignity and respect,” she said. “This amendment, this movement, is about who makes personal decisions for yourself and your family.”

Around the same time the abortion campaign was announced, a separate coalition organized to oppose them. That group, called Missouri Stands with Women, spent the past few months leading a “decline to sign” campaign, urging people not to sign the initiative petition. So far, they’ve been vastly out-fundraised by Missourians for Constitutional Freedom.

“Out-of-state Big Abortion supporters think the fight is over,” Stephanie Bell, with Missouri Stands With Women, said in a statement Friday. “They could not be more wrong when it comes to standing up for life in Missouri.”

Anti-abortion groups say more aggressive approach necessary to stop Missouri amendment

The abortion petition is among five citizen-led ballot measure campaigns expected to turn truckloads of signatures over to the Secretary of State’s office before 5 p.m. Sunday.

On Thursday, Winning for Missouri Education, which is a coalition of Missouri professional sports franchises, submitted more than 340,000 signatures in the hopes of putting the legalization of sports gambling on the ballot.

A day earlier, more than 210,000 signatures were delivered for a campaign hoping to ask Missouri voters to mandate paid sick leave and raise the state’s minimum wage to $13.75 beginning in January 2025 and $15 in 2026.

JoDonn Chaney, a spokesman for the Secretary of State, said it is unlikely signature verification will be finalized in time for any of the ballot measures to land on the August primary. 

The Independent’s Annelise Hanshaw contributed.

Students hold up anti-abortion signs at the Midwest March for Life on May 1 at the Missouri State Capitol (Anna Spoerre/Missouri Independent).

Wednesday’s Midwest March for Life at the Missouri Capitol had a different tone this year. It was about fighting. 

Nearly two years ago, the crowd celebrated Missouri becoming the first state to ban abortion after Roe V. Wade was overturned. But on Wednesday, a new worry loomed over the annual event: Abortion could soon be enshrined in the Missouri Constitution.

“If God doesn’t intervene in this process,” Paul Shipman, with the Christian radio program Bott Radio Network, said at a rally on the statehouse steps Wednesday,  “it just kind of shows you the direction where the nation is going and the direction where the state of Missouri is going.”

After recent losses in states like Kansas and Ohio, anti-abortion activists say they must take a more aggressive approach in Missouri, using a low-budget grassroots strategy to convince Missourians not to sign the initiative petition that would put a constitutional right to an abortion in the hands of voters. 

They enlisted elected officials to publicly decry the ballot measure. They set up a hotline to report the location of signature gatherers so volunteers could show up and hand out “Decline to Sign” materials. And they stoked unsubstantiated fears about the initiative petition process, such as the notion that it could result in widespread identity theft. 

And with a Sunday deadline to turn in signatures for proposed initiative petitions, their message and strategy is transforming from “decline to sign” to “withdraw your signature,” with fliers distributed Wednesday hoping to reach those “who regret signing – or who mistakenly signed.” 

After signatures are turned in, anti-abortion advocates plan to pour over them to make sure anyone who opts out isn’t counted. 

Anti-abortion organizers interviewed by The Independent, both in Missouri and nationally, say the biggest lesson they learned from a series of defeats across the country over the last two years is that they have to engage their supporters earlier in the process. 

Missouri could be the first test of the new strategy, even as abortion-rights supporters are raising millions more to get the issue on the November ballot. 

“It is the work that is being done on the ground in Missouri that has not happened in any other state across the entire nation,” said Brian Westbrook, CEO of St. Louis-based Coalition Life. “It doesn’t require tens of millions of dollars to get that ground game. That groundwork is already happening.”

Missourians for Constitutional Freedom, the campaign behind the abortion-rights initiative petition, has until Sunday to turn in more than 171,000 signatures from 8% of registered voters across six of Missouri’s eight congressional districts. 

Mallory Schwarz, executive director of Abortion Action Missouri, which is a leader in the abortion initiative petition coalition, said she remains confident the campaign will hit its signature goal. She didn’t share where their numbers currently stand ahead of the deadline, but Schwarz said the tactics from the anti-abortion side boost her confidence that abortion is a winning issue.

“If they were confident that people were aligned with them,” she said, “they wouldn’t resort to tactics like blatant lies, disinformation and harassment.” 

‘Our track record has not been good’

Anti-abortion groups interviewed by The Independent are focused on communicating three main points to voters: They believe the constitutional amendment goes farther than Roe; they say the amendment would harm health and safety protections for mothers; and they argue it will eliminate parental consent laws. 

Abortion-rights groups have said these claims have no merit whatsoever. The decision to move forward with an amendment including viability limit, often considered to be around 24 weeks, rather than no ban at all was considered a compromise position rather than an extreme one.

Susan Klein, executive director with Missouri Right to Life, said her organization has teams across the state who will file requests under the state’s open records laws to obtain copies of all the signatures obtained by Missourians for Constitutional Freedom. They plan to make sure any names she says were scratched out by people who regretted signing are not counted.

Missouri’s messaging is consistent with the strategy being deployed in six other states with abortion measures heading for the ballot, said Kelsey Pritchard, state public affairs director at Susan B. Anthony Pro-Life America.

Jamie Morris, executive director of the Missouri Catholic Conference, said the results in other elections made it clear that anti-abortion groups needed a new strategy. The Catholic dioceses in Missouri are helping spread the movement’s message and encouraging parishioners not to sign the abortion-rights petition. 

“Our track record has not been good,” he said. “From the pro-life side, we’ve always kind of been used to making one particular argument. And obviously, that was not resonating in some of the other states.”

Morris said the movement isn’t changing its position, but rather it is rethinking its messaging to focus increasingly on mothers as well as the “unborn child.” 

“We’ve done a good job of trying to limit the supply of abortions in the state, but what can we do to limit the demand?” Morris said. 

In neighboring Kansas in 2022, the Catholic church donated hundreds of thousands of dollars in a failed attempt to pass an amendment that would remove the right to abortion from that state’s constitution.

So far, the Missouri Catholic Conference has been one of the main donors to Missouri Stands with Women, the only campaign focused solely on actively opposing the abortion initiative petition, contributing $5,001. 

Morris said Missouri’s dioceses so far have not fundraised on this issue, but if the measure lands on the ballot, he imagines there will be more serious conversations about financial contributions.

Decline to sign

On a recent Saturday in late April, Republican state Sen. Mary Elizabeth Coleman stood outside her hometown library in Arnold and asked constituents not to sign the abortion-rights initiative. 

Connie Doty, 74, a longtime Arnold resident and an escort with Abortion Action Missouri, was volunteering to collect signatures that day.

Doty said library staff eventually asked her and the other volunteers to stay on the sidewalk. When Doty stepped into the parking lot at one point to let someone take a picture of the ballot initiative, she says Coleman followed her and told the person in the vehicle not to sign it. 

A short time later, after Doty refused to leave for stepping off the sidewalk, she said three police vehicles showed up. They told everyone to “be nice and be safe,” Doty recalls, then left. 

Doty said she was not phased, thanks to her decade of experience as an abortion clinic escort encountering protesters who try to stop women from getting abortions. But she said she was alarmed to see her own state senator among the two anti-abortion protesters who showed up.

“Considering that Sen. Coleman was doing this to her constituents,” Doty said, “I found pretty deplorable.” 

Doty said despite the interruption, they collected 143 signatures in a couple hours.

“They’re very much afraid that the issue will get on the ballot,” Doty said. “And if it gets on the ballot, people will pass it.”

Coleman could not be reached for comment Wednesday. 

Kellie Copeland executive director of Pro-Choice Ohio, said anti-abortion advocates used similar tactics during their 2023 campaign, including instances where police were called on signature collectors.

“Everything about that frankly shows they know that they don’t have the will of the people,” Copeland said. “Why else would they do that?”

A more aggressive strategy

Sam Lee doesn’t want to talk about November. The longtime Missouri anti-abortion lobbyist has his sights set on May 5.

He said other states where anti-abortion groups have taken the approach of only trying to beat abortion measures at the ballot box have lost. That’s why in Missouri, efforts began much earlier.

“The Decline to Sign (strategy) overall has just been more aggressive in Missouri by a variety of groups,” Lee said. “Not just one group or even one church. It is THE strategy.” 

Lee said Missouri’s approach has been much more grassroots, spread through social media, sermons and at dining tables. 

“Tell your family member not to sign,” he said. “Tell your neighbor not to sign.”

When Lee is asked by some what he’s afraid of, he said it’s simple: “I just don’t think this should be on the ballot. I think it’s wrong. Why should you give people an opportunity to vote for something that is bad?” 

Missouri Stands with Women, of which Lee is president, has been distributing messaging, including through paid Facebook ads, encouraging people not to sign.

One in particular depicts a man portrayed in a mugshot offering a pen in his hand. The word “felonies” is in quotes beside the drawing. 

“It’s a pretty clever ad, actually,” Lee said. “Is there a guarantee these signatures cannot be duplicated and used for identity theft? Is it a real issue or not? Well I don’t know. It’s been raised elsewhere.”

JoDonn Chaney, a spokesman for the Missouri Secretary of State’s office, said he’s not aware of any threat of identity theft during the signature gathering process at this point. He said the office’s larger focus is ensuring people know and understand what they’re signing. 

Lee said his campaign is leaning into a 2005 California law that prohibits the sale or transfer of voter data collected through initiative petitions to other countries after concerns were raised when an initiative petition campaign outsourced signature verification to a firm in India. 

So far, Chaney said, the office has received “a handful” of applications to withdraw signatures from the abortion initiative petition. 

According to records obtained by The Independent through Missouri’s Sunshine Law, the Secretary of State’s office has received about 140 requests for signature withdrawals from the abortion ballot initiative. 

Most did not provide an explanation for why they changed their mind, but one Columbia resident wrote: “I let a very pushy person with a petition make me feel like I needed to sign. Immediately after, all the reasons not to sign flooded my head. Someone needs to speak for the unborn.”

On Wednesday morning, the crowd of at least several hundred people gathered on the front lawn of the Capitol, including many high school students, were encouraged to stall signature gatherers if they encounter them on a sidewalk or at their door in a final push to defeat the measure before it gets to a vote. 

Michael Merchant, 31, based in St. Louis and with Students for Life, said it would be easier if the threshold to pass a constitutional amendment was more than a simple majority. Legislation seeking to increase the threshold for amendments to pass through the initiative petition process has cleared the House and Senate, but dysfunction in the Senate has put its chances at risk.  

“As much as I like to be optimistic, I’m not 100% confident that we can get 50% (in opposition),” Merchant said. “The main thing we would have to do is convince people that it’s an extreme thing.”

Merchant said he may be able to sway more people who are on the fence by pointing out to them how few limits on abortion would exist under the amendment. Advocates of abortion rights have said limits on abortion access often harm those who are most in need of the procedure, including those with medically-complicated pregnancies.

Missouri Secretary of State Jay Ashcroft, who attended Wednesday’s rally, said he believes his party can defeat an abortion ballot measure whether a higher threshold for passing citizen-led ballot measures is ultimately passed or not.

“I’m not a political consultant,” Ashcroft said, holding an anti-abortion sign at Wednesday’s march. “I just want to make sure that people know what this amendment will actually do. That it’s abortion from conception until the very last second that the last toenail leaves the birth canal.”

A hand casting a vote in a ballot box for an election in Missouri (Getty Images).

Legislation seeking to make it harder to change Missouri’s constitution through the initiative petition process was approved by the Missouri House on Thursday, sending it back to the Senate for a possible showdown between Republicans and Democrats over “ballot candy.” 

The bill was initially approved earlier this year after Democrats ended their 21-hour filibuster in exchange for the removal of “ballot candy” provisions — referring to unrelated additions to a ballot measure designed to win voters who are skeptical of a proposal’s main focus. 

On Thursday, the House added language to the bill that would ask Missourians if they want to change the constitution to define legal voters as citizens of the United States as well as whether they want to prohibit foreign entities from sponsoring initiative petitions. 

Democrats called the additions “unnecessary” and “deceptive.”

“This feels to me like another situation where this body is being asked to bend to the will of the Senate,” said state Rep. Eric Woods, a Democrat from Kansas City. “We are putting this bad stuff back on to send it back over there and watch the Senate explode again as if we aren’t already in enough turmoil in this building.” 

After the Senate vote in February, state Sen. Mary Elizabeth Colemen, a Republican from Arnold and the bill’s sponsor, asked the House Committee on Elections and Elected Officials  to reinstate the “ballot candy.”

The committee complied. After an hour-long debate Thursday morning, the bill ultimately passed, with House Majority Leader Jon Patterson of Lee’s Summit the lone “no” vote among his Republican colleagues.

State Rep. Alex Riley, a Republican from Springfield who sponsored the bill in the House, said the amendment, if adopted by the people, would create “a broader geographic consensus from across the state.”

Bill ending Medicaid reimbursements to Planned Parenthood heads to Missouri governor

Citizen-led initiative petitions currently require signatures from 8% of voters in six of the state’s eight congressional districts. To pass once on the ballot, a statewide vote of 50% plus one is required — a simple majority vote.

The version of the legislation passed Thursday would require that constitutional amendments pass by both a simple majority of votes statewide and a majority of votes in at least a majority of the votes in Missouri’s congressional districts. It would also require the General Assembly have the approval of at least four-sevenths of the members in each chamber to make any modifications to a citizen-led constitutional amendment within two years of when it goes into effect.

An analysis by The Independent found that under the concurrent majority standard being proposed, as few as 23% of voters could defeat a ballot measure. This was done by looking at the majority in the four districts with the fewest number of voters in 2020 and 2022.

Republicans argued this is about engaging all voters, no matter if they live in an urban or rural area. 

“Surely the ratification of something as sacred as the framework to our governance as a state should require something greater than just simply a simple majority statewide,” said state Rep. Brad Banderman, a Republican from St. Clair.

State Rep. Jamie Gragg, a Republican from Ozark, said the legislation would give his constituents in Christian County more voice.

“I have a very out-in-the-country district. My people do not have a vote,” Gragg said. “This will make the people in my district count, because right now they don’t.”

State Rep. Peter Merideth, a Democrat from St. Louis, said under the current framework of one person one vote, Gragg was flat-out wrong.

“If he thinks that it was St. Louis and Kansas City that elected our governor or elected Josh Hawley, I’m sorry he’s not paying attention,” Merideth said. “Or he’s just lying.” 

On Thursday, state Rep. Maggie Nurrenbern, a Democrat from Kansas City, brought the conversation back to abortion. The issue has been an undercurrent in this year’s initiative petition debate.

She recalled the end of session last year, when House Speaker Dean Plocher, a Republican from Des Peres, said his party expected an attempt to legalize abortion would land on the ballot and pass. 

So far, Plocher has been right. A campaign to legalize abortion up until fetal viability in Missouri has raised millions of dollars as they race toward a May 5 deadline to gather the 171,000 necessary signatures to end up on the statewide ballot.  

The main champions of the legislation seeking to change the initiative petition process have been anti-abortion groups. 

Democrats remain adamant voters will see through the “ballot candy” if the initiative petition legislation makes it to the ballot.

“Mark my words, this will be defeated. Missourians will say no to minority rule,” Nurrenbern said of the initiative petition bill. “Our folks in suburban districts are going to be coming out in record numbers to make sure that all of you know that they’re not going to be tricked.”

In the meantime, Nurrenbern said she hopes that when the bill reaches the Senate floor, “it just all implodes.”

This story was updated at 9:20 a.m. to reflect that citizen-led initiative petitions currently require signatures from 8% of voters in six of the state’s eight congressional districts.

The Planned Parenthood clinic in St. Louis on June 24, 2022 (Tessa Weinberg/Missouri Independent).

A bill that would make Missouri the fourth state to ban Medicaid reimbursements to Planned Parenthood is on its way to the governor. 

On Wednesday, the Missouri House in a vote down party lines approved legislation that would end Medicaid reimbursements to any health centers affiliated with abortion providers. Republicans are confident they’ve landed on a strategy that will finally stick after two failed attempts to pass a similar restriction through the state budget were struck down by state courts.

This legislation, originally filed by Republican state Rep, Cody Smith of Carthage, is nearly identical to a bill filed by state Sen. Mary Elizabeth Coleman, a Republican from Arnold, which was blocked by a Democratic filibuster in February. 

Senate Democrats filibustered for more than 11 hours earlier this month, arguing that the legislation will harm Missouri’s low-income patients. The filibuster was eventually abandoned when Republicans agreed to take out a provision that also would have ended contracts with organizations founded by eugenicists.

Democrats arguing in opposition to the bill on Wednesday said the state’s health care safety net cannot reasonably support the thousands of Medicaid patients who could be displaced from Planned Parenthood for procedures like contraceptive care, STI testing, cancer screenings and wellness checks. 

“You’ve said they can just go somewhere else, but you haven’t told us where you think they’re just going to go,” said Deb Lavender, a Democrat from Manchester, adding that this year’s state budget does not include additional spending for safety net clinics across the state. 

House Minority Leader Crystal Quade, a Springfield Democrat running for governor, called the legislation “an act of petty vengeance” that will have a “devastating impact on women.”

Republicans stood by their long-held stance that no state funds should go to organizations affiliated with abortion providers.

Missouri was the first state to outlaw abortion after Roe v. Wade was overturned in June 2022. From June 2022 through 2023, there were 52 abortions performed in Missouri under the state’s emergency exemption, according to data from the Missouri Department of Health and Senior Services. 

None took place at Missouri Planned Parenthood clinics; however, Planned Parenthood clinics in the neighboring states of Kansas and Illinois still provide abortions.

“We are speaking about the absolute termination and destruction of an individual human life,” said state Rep. Justin Sparks, a Republican from Wildwood. “That life that is growing inside is human.” 

Planned Parenthood Great Plains and Planned Parenthood of St. Louis Region and Southwest Missouri, which have clinics in Missouri, said in a statement immediately following the vote that they will continue trying to serve all patients, “no matter what.” 

Missouri’s safety net clinics 

The legislation approved Wednesday is Republican lawmakers’ third attempt in recent years to end Medicaid reimbursements to Planned Parenthood. Twice before, they tried and failed to cut Planned Parenthood’s funding through the state budget, but state courts ruled those attempts unconstitutional.

The latest attempt at the legislation was also passed in Arkansas several years ago. When Arkansas’ law was upheld by the 8th U.S. Circuit Court of Appeals in St. Louis, Planned Parenthood clinics in Arkansas immediately ceased seeing Medicaid patients. 

Missouri looks to mirror Arkansas law that forced Planned Parenthood to turn away patients

If the Missouri bill becomes law, Planned Parenthood leadership previously said they didn’t know if they could continue seeing patients insured by MO HealthNet, Missouri’s Medicaid program, arguing it would be a financial strain as clinics would no longer be reimbursed for the cost of seeing these patients. 

As of March, Planned Parenthood clinics in Missouri had been without Medicaid reimbursements for two years. At the time, Emily Wales, CEO and president of Planned Parenthood Great Plains, which oversees clinics in western Missouri, Arkansas, Kansas and Oklahoma, said her organization offset the cost of care for Missouri Medicaid patients through private fundraising. She was unsure how sustainable that would be in the long-term.

When Missouri lawmakers began proposing this legislation a few years ago, The Missouri Family Health Council Inc began informally surveying the capacity at the state’s safety net clinics, which take Medicaid patients.

The organization found wait times at the state’s Planned Parenthood clinics averaged between the same day and three days to get an appointment. Across the other safety net clinics, wait times averaged between five and seven weeks, with some clinics as few as two weeks and some pausing new patients completely.  

In 2022, across all 68 safety net clinics in the state that take Title X funding, around 24% of the clients were on Medicaid, said Michelle Trupiano, the council’s executive director.

MO HealthNet serves low-income and disabled citizens and has long banned funding for abortion, with limited exceptions. 

Planned Parenthood has said nearly one in five of their Missouri patients are on Medicaid.

Trupiano previously said Planned Parenthood is the primary family planning services provider for about 20,000 patients across the state.

During House debate Wednesday, state Rep. Rep. LaKeySha Bosley, a Democrat from St. Louis, revisited Missouri’s “abysmal” maternal mortality rate, saying as a Black woman, she is afraid to have a child in the state.

In Missouri, women on Medicaid are 10 times more likely to die within one year of pregnancy than those on private insurance, according to an August multi-year report on maternal mortality published by the Missouri Department of Health and Senior Services. Black mothers were three times more likely to die within a year of pregnancy than white mothers, according to the Pregnancy-Associated Mortality Review.  

Missouri is also fighting rising congenital syphilis cases. In 2022, Missouri recorded 81 congenital syphilis cases — the most in 30 years, the state health department reported. 

In the majority of Missouri’s rising cases of congenital syphilis, mothers had little to no prenatal care, highlighting a larger issue of maternal health care access, the health department noted.

Legislation that would add a syphilis test at 28 weeks pregnancy, giving providers enough time to treat the mother ahead of the child’s birth, received initial approval by the House on Monday as part of a women’s health omnibus bill.

“Women are going to come to the ballot and they’re going to remember this,” Bosley said, later adding: “So be ready.

An emergency clause adopted first by the Senate was voted down by the House on Wednesday. That clause would have meant the law would go into effect immediately upon being signed by the governor. Now, if signed by the governor, it won’t go into effect until Aug. 28. 

The bill’s passage Wednesday was a crucial step toward passing a plan to renew taxes set to expire later this year that are critical to funding Missouri’s Medicaid program  known as the federal reimbursement allowance.

Senate members of the Missouri Freedom Caucus, a team of the six Republicans in the chamber, have promised to filibuster renewal of the taxes until the governor signs the defund Planned Parenthood bill and the General Assembly approves a proposed constitutional amendment that would make it more difficult to pass constitutional amendments proposed by voter-led initiatives.

“It’s going to be very difficult to pass the renewal of some of the health care taxes over the objections of the Freedom Caucus down in Jefferson City if that bill that bans money going to Planned Parenthood doesn’t pass,” state Sen. Bill Eigel, a Republican from Weldon Spring who is running for governor, said on the conservative radio show NewsTalk STL early Wednesday morning. 

“There’s a lot of special interest swamp-types that really are desperate to see this health care tax that they’re talking about getting renewed,” he added. “I don’t see that happening if we’re not going to get a Planned Parenthood defund bill.” 

The exterior of Planned Parenthood Reproductive Health Services Center is seen on May 31, 2019 in St. Louis (Photo by Michael Thomas/Getty Images).

A bill that would make Planned Parenthood ineligible to receive reimbursements from the state’s Medicaid program passed out of the Missouri Senate early Wednesday morning after an 11-hour Democratic filibuster.

The bill now returns to the House, where it can be sent to Gov. Mike Parson to sign into law.

This legislation, originally filed by Republican state Rep. Cody Smith of Carthage, is nearly identical to a bill filed by state Sen. Mary Elizabeth Coleman, a Republican from Arnold, which was blocked by a Democratic filibuster in February. 

The legislation would make it financially tenuous, if not impossible, for the state’s Planned Parenthood clinics to continue seeing patients on Medicaid since the clinics would no longer be reimbursed for the cost of seeing these low-income patients.

Coleman, who is running for Secretary of State, said Tuesday afternoon that she hopes putting her bill into law makes it “abundantly clear to the state of Missouri that people who are engaged in, are associated with, who are providing abortions in the state of Missouri, shall be ineligible to be part of the Medicaid program.”

Missouri was the first state to outlaw abortion in June 2022 after the constitutional right to the procedure was overturned by the U.S. Supreme Court. From June 2022 through 2023 , there were 52 abortions performed in Missouri under the state’s emergency exemption, according to data from the Missouri Department of Health and Senior Services. 

None took place at Missouri Planned Parenthood clinics; however, Planned Parenthood clinics in the neighboring states of Kansas and Illinois still provide abortions.

“Dollars are fungible,” Coleman said Tuesday. 

Health professionals push to reduce congenital syphilis infections killing Missouri babies

Her Democratic colleagues blocked a vote on the legislation past midnight, arguing that the state’s health care safety net couldn’t reasonably support displaced Medicaid patients. 

State Sen. Tracy McCreery, a Democrat from Olivette, called the bill a “bizarre quest to just continue to punish Planned Parenthood.” 

“But the reality is it’s not punishing Planned Parenthood,” she said. “This is hurting our very own constituents.”

Missouri’s Medicaid program, called MO HealthNet, serves low-income and disabled citizens, and has long banned funding for abortion, with limited exceptions. Planned Parenthood clinics primarily provide contraceptives, STI testing, cancer screenings and wellness checks. 

The bill was ultimately approved along party lines around 12:30 a.m. 

Capacity at safety net clinics

The bills filed this session attempt to cut Planned Parenthood’s funding through state law after Missouri Republicans twice tried to end Medicaid reimbursements through the state budget. Both times, including as recently as February, courts ruled those attempts unconstitutional.

Despite the legal victories, Planned Parenthood affiliates in Missouri last month said they have not received any Medicaid reimbursements since 2022. 

Emily Wales, CEO and president of Planned Parenthood Great Plains, which oversees clinics in western Missouri, Kansas, Oklahoma and Arkansas, said previously that her organization has been privately fundraising to offset the cost of care to continue seeing Missouri Medicaid patients. 

When a similar law passed in Arkansas several years ago, clinics immediately ceased seeing Medicaid patients. Arkansas’ law was upheld by the 8th U.S. Circuit Court of Appeals in St. Louis.

Nearly one in five Planned Parenthood patients in Missouri are on Medicaid. Wales said they’re still evaluating their options if the bill becomes law. 

Coleman on Tuesday said this bill is not about access to health care, reiterating that federally qualified health centers, which also take patients on Medicaid, could take on the patients. She again suggested that Planned Parenthood clinics could also drop their Planned Parenthood affiliation to become eligible for reimbursements. 

“It’s no politician’s business to tell somebody where they can and can’t go for healthcare,” McCreery said, emphasizing her concerns that patients won’t quickly be able to find new providers.

Missouri looks to mirror Arkansas law that forced Planned Parenthood to turn away patients

The Missouri Family Health Council Inc has over the past two years informally surveyed the capacity at the state’s safety net clinics. 

When calling to inquire about availability for new patients, the organization found wait times at the state’s Planned Parenthood clinics averaged between the same day and three days to get an appointment. Across the other safety net clinics, wait times averaged between five and seven weeks, with some clinics as few as two weeks and some pausing new patients completely.  

In 2022, across all 68 safety net clinics in the state that take Title X funding, around 24% of the clients were on Medicaid, said Michelle Trupiano, the council’s executive director. She previously testified that Planned Parenthood is the primary family planning services provider for about 20,000 patients across the state.

State Sen. Karla May, a Democrat from St. Louis, said in her travels around rural Missouri last year she heard a resounding cry for more health care providers. A bill like this, she argued, would create “chaos.”

McCreery on Tuesday brought forward an amendment that would exempt in vitro fertilization from Missouri’s current statute which states that life begins at conception. 

The amendment never made it to a vote, but it fueled much of the Democratic senators’ filibuster.  

“I assumed wrongly, stupidly, that when the legislature passed a total ban on abortion, that that would be enough. People would feel like they had their pro life credentials,” said state Sen. Lauren Arthur, a Democrat from Kansas City. “What I have since realized is it’s never enough.”

Legislation sponsored by Republican state Rep. John Black to make it more difficult to amend the state constitution through the initiative petition process was approved by the Missouri House on Wednesday (Tim Bommel/Missouri House Communications).

Two bills seeking to make it more difficult to amend the state constitution through the initiative petition process advanced through the Missouri House this week. 

On Wednesday, legislation sponsored by Republican state Rep. John Black of Marshfield was approved on a 106-49 vote. The only Republican to vote against the measure was House Majority Leader Jon Patterson of Lee’s Summit. 

Earlier in the week, a House committee approved a different version of the bill sponsored by state Sen. Mary Elizabeth Coleman that the Senate passed last month. 

If either version is approved by both chambers, the question would go on the statewide ballot in either August or November.

Citizen-led initiative petitions currently require signatures from 8% of voters in five of the state’s eight congressional districts. To pass once on the ballot, a statewide vote of 50% plus one is required — a simple majority vote.

Both the House and Senate versions make the process harder, but in very different ways. 

The House joint resolution would:

• Require signatures from 8% of registered voters in all eight congressional districts to qualify for the ballot. 
• Establish a forum hosted by the Secretary of State for voters to review and comment on proposed amendments before they head to the ballot.
• Require a ballot measure receive a majority of votes in a majority of Missouri’s congressional districts to pass.
• Require the General Assembly to have the approval of at least four-sevenths of the members in each chamber to make any modifications to citizen-led constitutional amendments within two years of when they go into effect.

The Senate joint resolution would: 

• Require that constitutional amendments pass by both a simple majority of votes statewide and a majority of votes in at least a majority of the votes in Missouri’s congressional districts. 
• Require the General Assembly to have the approval of at least four-sevenths of the members in each chamber to make any modifications to citizen-led constitutional amendments within two years of when it goes into effect.

‘This is about reproductive freedom’

Last May, House Speaker Dean Plocher, a Republican from Des Peres, said his party anticipated an initiative petition to legalize abortion would be brought forward and would pass. 

Since then, a campaign to legalize abortion to the point of fetal viability in Missouri has raised millions of dollars, most recently bringing in internationally-known model and Webster Groves native Karlie Kloss to campaign on their behalf.

Republicans in support of changing the initiative petition process have said their motivation is more wide-reaching than abortion and pre-dates the 2023 session, anti-abortion groups have been some of the main champions of the legislation.

But the bulk of Wednesday’s conversation centered on the most recent citizen-led amendment to pass.

In 2022, Missourians legalized recreational marijuana with 53% of voters in favor of the amendment.

In that election, Black said, 15 counties carried the “yes” vote, arguing that urban voters “basically imposed their will on the rest of the state.”

Republicans in favor of changing the initiative petition process have repeatedly pointed to the length of the state constitution, which includes 134 amendments, as a reason for reform. 

State Rep. Robert Sauls, a Democrat from Independence, countered that only 19 of the amendments came from initiative petitions. The rest came from the General Assembly. 

“This idea that the constitution has gotten out of control, well look in the mirror,” Sauls said. “We’re the reason that it has. Not these 19 amendments that the people have put on.”

An analysis by The Independent found that under the concurrent majority standard, as few as 23% of voters could defeat a ballot measure. This was done by looking at the majority in the four districts with the fewest number of voters in 2020 and 2022.

“You want a minority to be able to block a majority,” said state Rep. Joe Adams, a Democrat from University City. “That is shameful.”

State Rep. Doug Richey, a Republican from Excelsior Springs, said with a simple majority, it’s possible for those leading initiative petition efforts to “ignore” congressional districts and still succeed. 

“That is a significant move to value the voices of people in the state of Missouri no matter where they happen to live,” Richey said. “No matter what their perspective is.” 

Reference to the current abortion initiative petition wasn’t raised until late in the debate by state Rep. Patty Lewis, a Democrat from Kansas City. 

“This is about reproductive freedom,” Lewis said. “And it’s about taking away our vote to restore reproductive freedom in the state of Missouri.”

In approving Black’s legislation on Wednesday, the House made little mention of the “ballot candy” written into the resolution. 

The ballot candy, which refers to provisions added to ballot measures in order to win over voters, has become a major point of contention between Republicans and Democrats. In the proposed initiative petition bills, language has been included that would ask voters if they want to define legal voters as citizens of the US who live in Missouri and are registered to vote and whether they want to prohibit foreign entities from sponsoring initiative petitions.

Democrats argue the inclusion of the ballot candy is an attempt by Republicans to mislead voters and distract from the effort to weaken the initiative petition process. In the Senate, a 21-hour filibuster ended with Republicans agreeing to remove the ballot candy in exchange for Democrats allowing the bill to come up for a vote. 

The House restored the ballot candy at Coleman’s request, setting up a potential showdown in the Senate if the bill makes its way back to that chamber. 

This story was updated at 8:05 a.m. to reflect that under state Rep. John Black’s bill, ballot measures would need to receive a majority of votes in a majority of Missouri’s congressional districts.

Senate Majority Leader Chuck Schumer announced on Wednesday that the Senate will vote in June on legislation guaranteeing the right to access contraception (Getty Images)

Missourians overwhelmingly support access to contraceptives, but some fear their lawmakers could pass laws limiting that availability, a new poll shows.

The survey, released Thursday by The Right Time, a family planning initiative through the Missouri Family Health Council Inc., polled 1,000 Missourians between the ages of 18 and 35, split almost evenly between Democrats, Republicans and Independents.

Michelle Trupiano, executive director of the Missouri Family Health Council, said the poll confirmed what she already believed to be true: birth control is not controversial among Missourians.

“During a time when many issues divide people in our state,” she said. “Birth control enjoys near universal support.”

Many of those polled expressed concern that their lawmakers felt differently. About half the Republican respondents, 84% of the Democratic respondents and 61% of the independent respondents said they are very or somewhat concerned the legislature will push laws restricting birth control. 

“We can’t take anything for granted in terms of what our freedoms and ability to access healthcare looks like,” Trupiano said. “Those that fought to undermine Roe v. Wade are also fighting to limit access to birth control, so yes, very understandable why people are worried.”

Health professionals push to reduce congenital syphilis infections killing Missouri babies

The respondents also pointed to both cost and insurance as their biggest barriers to accessing contraceptives. Asked if people should be allowed to access an annual supply of birth control, 77% said yes.

“Picking up your prescription every one month to three months at your pharmacist is an onerous to-do for the busy lives that people live today,” said Mandy Hagseth, the council’s director of policy and external affairs.

Hagseth said in talking with women and providers across Missouri, access to clinics, lack of consistent transportation and balancing work and children is often a barrier to picking up their contraception consistently, which can create gaps in use and increase the chances of an unintended pregnancy. Nearly all abortions are illegal in Missouri.

A bill worked on by the council and the National Council of Jewish Women St. Louis would alleviate some of that burden, allowing women to fill an annual birth control prescription at a pharmacy once a year if they prefer. 

They started pitching the legislation, which already exists in 25 states, including Texas, in 2019, Hagseth said.

This year, she said, it was finally prioritized by both Democrats and Republicans, including state Rep. Tara Peters, a Republican from Rolla.

The legislation is now included in a larger bill sponsored by Peters along with a smattering of other health care provisions. 

“Women have to have access to birth control,” Peters said.

Peters, who opposes abortion,  said she assumed every lawmaker would be on board. She says she quickly learned that wasn’t the case, as some Republican colleagues expressed concerns that the legislation was about abortifacients. 

It is not. 

“You’ve got so many facets of people that believe certain things, so it’s very hard to convince this side that this is something that’s important,” Peters said Thursday. “It’s kind of been a frustrating process, I’m not going to lie about that.”

But largely, the birth-control legislation has had bipartisan support, with both Democratic and Republican co-sponsors in the House and Senate.

Peters, who hopes to bring her bill to the House floor in early April, said this legislation in particular could make the lives of women in her rural district easier.

According to data compiled by Power to Decide, more than 373,000 Missouri women live in contraceptive deserts, which they define as a place where there’s not reasonable access to a full range of contraceptive methods. Most are in rural counties.

Peters said the moment is ripe. It’s an election year, polling shows Missourians are supportive of increased birth control access and an effort to legalize abortion may end up on the ballot.

“There’s not a better time than now to make it count,” she said. “That we’re making an effort to show that women’s contraceptives is important.” 

Correction: This story was updated at 8:55 a.m. to clarify that 77% of survey respondents believe people should be allowed to access an annual supply of birth control

The exterior of a Planned Parenthood Reproductive Health Services Center on May 28, 2019 in St Louis (Michael B. Thomas/Getty Images).

When Morgan Johnson walked into her annual well woman’s exam at the Little Rock Planned Parenthood in 2018, the Arkansas clinic had just gotten a call from the governor’s office.

A new state law that had been working its way through the courts had just gone into effect — Planned Parenthood could no longer receive Medicaid reimbursements. That meant Johnson, then a student, single mom to twin girls and patient on the federal insurance program for those living in poverty, had to find a new provider. 

“I felt devalued as a person who didn’t have insurance,” she said, recalling thinking, “Wow, Arkansas really hates women. This isn’t about abortion.”

She said it took her months to get into a new provider who took her Medicaid because wait lists were so long.

A few years earlier, Johnson said Planned Parenthood had been her lifeline after she had an ovarian cyst rupture while she was uninsured. She said the clinic signed her up for Medicaid and got her into regular appointments, which ultimately kept her from leaving school, her initial plan once the debilitating pain began. 

“They were my doctor when I did not have one. If not for that, I probably would’ve dropped out,” Johnson said. “Who knows where I would be without them.” 

Arkansas’ law was upheld by the 8th U.S. Circuit Court of Appeals in St. Louis. Since then, Missouri has tried twice to enact a similar restriction through the state budget, both times ending with the state Supreme Court ruling the effort unconstitutional. 

Now, Missouri Republicans are trying again to replicate Arkansas, this time by changing state law. Proponents of Missouri’s legislation argue that no public funding should be going to clinics affiliated with abortion providers in other states. 

Planned Parenthood clinics in Missouri no longer offer the procedure, which has been nearly completely banned in the state since 2022. Their affiliates in Kansas and Illinois do.

Despite the legal victories, Planned Parenthood clinics have not received any Medicaid reimbursements since 2022. Emily Wales, CEO and president of Planned Parenthood Great Plains, which oversees clinics in western Missouri, Kansas, Oklahoma and Arkansas, said her organization has been privately fundraising to offset the cost of care to continue seeing Missouri Medicaid patients. 

But she’s not sure how sustainable that is. 

Asked if they would have to stop seeing Medicaid patients immediately if this legislation became law, Wales said they’re still evaluating their legal options and whether they might apply for federal funds.

“The real issue for us is that the public safety net for low-resourced patients in Missouri is already so strained that when you start using a very small number of resources and try to expand care, it’s just not possible,” Wales said. “It’s hard to imagine that there won’t be people who are affected — maybe not immediately — both in a matter of months where we’re just not able to cover the cost of care for everyone who needs us.”

Those who support the bills, including anti-abortion advocates, have said that it’s immoral for any public funds to go to groups that promote abortion. Historically, state leaders have agreed, prohibiting state money from paying for abortions even before the U.S. Supreme Court overturned Roe v. Wade.

Supporters of the proposed Missouri law argue the nearly one in five Planned Parenthood patients on Medicaid can simply find a new provider. Those opposed say that’s not so simple. 

Fundraising to keep patients in the door

The House has already passed a bill, sponsored by Republican state Rep. Cody Smith of Carthage, that would make it illegal for any public funds, including Medicaid reimbursements, to go to abortion facilities or their affiliates, including Planned Parenthood.

Smith’s bill was also approved by a Senate committee, putting it potentially one step away from the governor’s desk. 

An identical Senate version, sponsored by GOP state Sens. Mary Elizabeth Coleman and Nick Schroer, ran into a Democratic filibuster earlier this year. At a January hearing, Schroer said other health care providers could “pick up the slack” if the law passed.

Since the U.S. Supreme Court overturned Roe v. Wade in June 2022, the Planned Parenthood clinics in Missouri have only provided services such as contraceptives, STI testing, cancer screenings and wellness checks. Missouri’s Medicaid program, called MO HealthNet, serves low-income and disabled citizens, and has long banned funding for abortion, with limited exceptions. 

For the past two years, the Missouri Family Health Council Inc, has informally surveyed the capacity at the state’s safety net clinics, calling to inquire about wait times for new patients. 

The organization found wait times for new patients at the state’s Planned Parenthood clinics averaged between the same day and three days to get an appointment. Across the other safety net clinics, wait times averaged between five and seven weeks, with some clinics as few as two weeks and some pausing new patients completely.

In 2022, across all 68 safety net clinics in the state that take Title X funding, around 24% of the clients were on Medicaid, said Michelle Trupiano, the council’s executive director. She previously testified that Planned Parenthood is the primary family planning services provider for about 20,000 patients across the state.

“Excluding one of the most qualified well known and high volume family planning providers from participating in Medicaid and other programs would have a devastating impact on all safety net providers and patients,” she said. “Safety nets are already stretched too thin, and this would just put a giant hole in the safety nets and at the end of the day, leave clients with a huge gap in access to care.”

Neither Planned Parenthood Great Plains, which oversees clinics in Columbia and Kansas City, nor Planned Parenthood St. Louis Region and Southwest Missouri have received Medicaid reimbursements for the past two years. This is despite winning in court last month, when, for the second time in four years, the state’s highest court rebuked lawmakers’s efforts to ban abortion providers and their affiliates from receiving Medicaid reimbursements through a line in the 2022 state budget.

Medicaid reimbursements are extremely low and contribute to challenges recruiting, Wales said, and retaining providers across safety net clinics. But every dollar makes a difference.

“We have to fundraise to keep the doors open,” she said. “So when you take out any of the resources, even if they’re really small, it absolutely will make it harder for us to provide care.” 

Richard Muniz, interim president & CEO of Planned Parenthood of the St. Louis Region and Southwest Missouri, said such a law would impact their side of the state, too.

“Let’s be clear — Missouri’s safety net cannot keep up without Planned Parenthood health centers, which provide high-quality health care to thousands of patients a year,” he said. “These attacks on care come at a huge cost to our patients’ well-being and the ramifications are felt by all Missourians across the state.”

The Independent reached out to several safety net providers to inquire about their current wait times for new patients. None offered comments. 

Access to care beyond abortion

Maggie Olivia, with Abortion Action Missouri, has been among several Missourians who’ve shown up to Jefferson City to testify against the bills in recent months. 

Olivia used Planned Parenthood as a provider for a decade beginning in high school, continuing after college when she was on Medicaid. She still utilizes Planned Parenthood clinics today even after getting private insurance.

“Being a survivor of sexual violence at a young age makes accessing that kind of intimate care like gynecological care all the more difficult and uncomfortable,” Olivia said. “Planned Parenthood centers are the only place I can consistently rely on to treat me in a respectful and trauma informed way.” 

She said in the years when Planned Parenthood wasn’t an option based on her location, she delayed care because she couldn’t go to the provider she already trusted.

Tara Mancini, director of public policy at Power to Decide, a nonprofit that advocates for access to contraceptives, said bills such as these can also harm access to family planning. 

Birth control is a journey, she said, and patients should have a plethora of options. 

“It’s not enough just to have the pill or condoms or whatnot because that may not work for everybody and their lifestyle and their body,” Mancini said, adding that health centers aren’t required to have a wide range of contraceptives on hand, while Planned Parenthood often offers more options.

She pointed to research out of Texas that found after the state eliminated Planned Parenthood from the state’s Healthy Texas Women program a decade ago, the use of birth control declined significantly. 

According to data compiled by Power to Decide, more than 373,000 Missouri women live in contraceptive deserts, which they define as a place where there’s not reasonable access to a full range of contraceptive methods. Nearly 62,000 Missouri women live in counties that don’t have any health centers that provide a full range of contraceptive methods.

She said bills cutting off Medicaid reimbursements to Planned Parenthood would only further decrease access to contraceptives.

Providers and wait times

Kate Wagner, a family nurse practitioner with the Jefferson County Health Department, a safety net provider, recently saw a patient who came in for birth control. 

The patient had a history of sexual trauma and was nervous to do a full exam. Wagner told her they could reschedule her cancer screening for a day she felt more comfortable, then she filled her birth control prescription and talked her through how a pap smear works. 

Wagner promised that she wouldn’t bother to shave her legs, so the patient shouldn’t feel like she needed to, either. She said in private practice, she might not have been able to afford spending so much time with the patient. 

That personal connection and the ability to spend more time with patients than she might get at a private practice is why she’s stayed.

“My hair may have changed colors in the last 15 years, I may have a few more wrinkles, but I’m the same girl. I have the same corny jokes,” Wagner said. “My patients know me; they know what they’re gonna get.”

She’s a veteran at the health department’s family planning and STI clinic where she splits time between locations in Arnold and Hillsboro, both on the outskirts of St. Louis County. She sees about 25 patients a week, mostly for family planning. If she has to call in sick, the clinic is canceled for the day.

“There are definitely not enough providers to go around,” Wagner said.

Getting a new patient on Medicaid into their door can require “a triangulation of logistics,” she said. While there’s always a physician who can see them, the more pressing question is how soon.

Comfort and continuity is so important, especially for patients who are uninsured and more likely to have a history of trauma, Wagner said.

To limit or close a safety net provider anywhere in Missouri would be “devastating,” she argued, akin to closing a bridge that will have broader impacts on the whole infrastructure, not just those who travel across it.

Johnson, the Arkansas woman who found herself in need of a new provider, is now back with Planned Parenthood on her private insurance. 

In the years since the Arkansas law went into effect, she earned two degrees, became a geologist and turned 40. 

She also took up activism, driving to a few events to tell her story and speak on behalf of Planned Parenthood before the pandemic put her advocacy on pause.

Despite taking a step back from that volunteer work a few years ago, Johnson still thinks about the women across her state who were left scrambling like herself. She hopes they’re OK.

“It’s an utter shame,” she said. “There’s no telling how many women in Arkansas have fallen through the cracks.”

Jamie Corley, a longtime GOP Congressional staffer, announced she is running for Missouri Secretary of State after ending a campaign effort for an initiative petition that would add rape and incest exceptions to Missouri’s abortion ban and legalize abortion up to 12 weeks (photo submitted by Jamie Corley).

A longtime GOP Congressional staffer and leader of an abandoned campaign to legalize abortion is now running for Missouri Secretary of State. 

Jamie Corley, a Republican from University City, officially filed to run in the GOP primary on Monday. This is her first time running for public office.

“There is more to me than abortion, actually,” Corley said after making headlines for the past year for her campaign to legalize the procedure up to 12 weeks and add exceptions for victims of rape and incest. 

She joins Republicans Valentina Gomez, a real estate investor also making her first run for office; Greene County Clerk Shane Schoeller; state Sen. Denny Hoskins of Warrensburg and state Rep. Adam Schwadron of St. Charles. The deadline to file to run in the August primary is Tuesday.

Two Democrats are also in the race: Monique Williams of St. Louis and state Rep. Barbara Phifer of Kirkwood.

Missouri Secretary of State Jay Ashcroft, a Republican, is leaving office to run for governor. 

Corley said she made the decision after Senate President Pro Tem Caleb Rowden dropped out of the race last week, leaving open a moderate lane.

Her resume includes several years working in communications for a handful of Republican lawmakers. Corley described herself as having a deep knowledge of banking policy after having managed the banking communications portfolio for former U.S. Sen. Bob Corker, a Republican from Tennessee.

She also noted her experience as a small business owner. In 2016 Corley created a nonpartisan newsletter called The Bridge, which she later sold to her co-founder. In addition to overseeing elections, the secretary of state’s office also handles business filings. 

“I want to make it as seamless as possible to do business in Missouri,” Corley said, describing herself as a policy-nerd rather than a “bombastic candidate.”

Corley said her experience filing several initiative petitions informed her decision to run.

Last year, she sued Ashcroft, arguing the ballot summary and fiscal note he wrote for her initiative petitions were inaccurate and unfair. She dropped the lawsuit after dropping her campaign. 

Corley ended her abortion campaign in February after she was out-fundraised by Missourians for Constitutional Freedom, a coalition whose backers include Abortion Action Missouri, the ACLU of Missouri and Planned Parenthood that’s attempting to put a constitutional amendment on the statewide ballot that would legalize abortion up to the point of fetal viability. 

Corley continues to lead Missouri Women and Family Research Fund, a nonprofit she launched late last year. After dropping her ballot initiative campaign, Corley said she hoped to focus her nonprofit around conducting data-driven research and polling to inform legislators on the effects of abortion bans. 

“During the ballot initiative, and even before the ballot initiative, I talked to Republicans for the past two years about a really hot button issue and a lot of people opened up to me in ways that they’re not telling their Republican book club,” she said.

Corley doesn’t believe her abortion stance will affect her chances at a fair fight, adding that she’s more closely aligned with former President Donald Trump’s stance on abortion than the other Republican candidates. 

The Republican nominee for president has said he supports a 15 week federal ban.

“These candidates who just insist on defending this abortion ban,” Corley said, “you’re really bucking President Trump and that’s a strategic decision they’ll have to make.” 

Christian King, a doula with Uzazi Village in Kansas City, wraps Mikia Marshall, 33, with a kanga cloth to help take pressure off her stomach on Feb. 27, 2024 (Anna Spoerre/Missouri Independent).

Christian King watched her sister lie sick in a hospital bed for days after suffering a placental abruption while giving birth.

Finally, after their mother pleaded with hospital staff to run more tests, they learned her blood count was dangerously low. Two blood transfusions later, she was back on her feet. 

The power of having an advocate during birth stayed with King. Not long after, she became a doula. 

It’s why King, a single mom of three working two jobs, has agreed to cut or eliminate her fees in order to ensure women on Medicaid can afford to access her doula services in the Kansas City area. Doulas offer support for families during pregnancy, delivery and postpartum, but do not deliver babies.

She’s not alone. In order to serve some of Missouri’s most vulnerable women, doulas say they have been giving up wages to make their services affordable to those who need it the most. 

In Missouri, doulas are not guaranteed a reimbursement through Medicaid for low-income patients. 

And as more rural areas of the state are labeled maternal health care deserts, birth centers, which can provide an alternative to hospitals in low-risk pregnancies, say they can help. The problem? They are impossible to license under current law. Without licensure, they are not eligible for Medicaid reimbursements, either. 

A bipartisan group of lawmakers have introduced a number of bills looking to make both doulas and birth centers more accessible across the state.

Identical bills filed by state Reps. Wendy Hausman, a Republican from St. Peters, and Jamie Johnson, a Democrat from Kansas City, would allow doulas registered with the state to be reimbursed through insurance. Both bills passed through committee Wednesday.

“There are many women who do not have faith in the medical community and they prefer to explore other avenues and other options for healthcare,” Hausman said during a hearing last month. “I believe that women deserve to be taken care of in a way that they’re most comfortable during this very complex time.”

A third bill from state Rep. Kent Haden, a Republican from Mexico, would de-designate birthing centers as ambulatory surgical centers, which would allow them to get licensure, and then Medicaid reimbursements. It has not yet been voted on in committee.

Birth centers don’t perform surgeries, so they shouldn’t have to meet the requirements of a facility that does, Haden said. He hopes the bill could be a solution for rural Missouri, which is in a “real conundrum” as rural hospitals continue to close. 

Haden said he’s also in support of the doula bills. 

A year ago, he didn’t know what a doula was. Now he’s convinced that without them, “we probably won’t change our maternal death loss postpartum or prepartum.”

Doulas ‘a necessity,’ not a luxury

Driving the conversation is Missouri’s abysmal maternal mortality rate. 

In Missouri, women on Medicaid are 10 times more likely to die within a year of pregnancy than women on private insurance, according to a 2023 report from the state’s Pregnancy-Associated Mortality Review. Black mothers were three times more likely to die within a year of pregnancy than white mothers. 

Of the 70 or so pregnancy-related deaths each year in Missouri, the majority were deemed preventable.

Last year, the Missouri legislature extended postpartum Medicaid coverage from 60 days to one year. Several months after he signed the bill, Gov. Mike Parson announced a plan to invest $4.3 million to improve the state’s birth outcomes, which he called “embarrassing and absolutely unacceptable.”

But he has said more action is still needed. 

Johnson pointed her colleagues to a 2023 March of Dimes report that gave Missouri a D- grade for preterm births. Doulas are one of the solutions suggested by the report.

King, 33, has been a PRN doula through Uzazi Village for five years. The non-profit, which sits in one of Kansas City’s poorest zip codes, strives to improve Black birth outcomes in part through training and hiring doulas.

She learned about Uzazi Village after birthing her third child at a Kansas City hospital. With her mother unable to attend, King called on her friends, who showed up ready to work.

They held her hands, readied washcloths, took photos, fed her, advocated for her.

“It was beautiful the way everyone was in action,” King said. “They made me laugh when I wanted to laugh. It was the best birth experience I have ever had having just my village doing what women do for each other.”

Now King, who is also an 8th grade math and social studies teacher, has walked about 100 women through pregnancy as a doula. Mikia Marshall, 33, of Kansas City, was one of the latest. 

“I’ve never done this before and I’m scared,” Marshall told King when they met in Uzazi Village’s colorful community room in late February. “What if he gets stuck? What if I can’t push?” 

Marshall, then 37 weeks pregnant with her son, said when her mother could no longer be at her birth, she found help at Uzazi Village, desperate to have someone with knowledge by her side.

King walked Marshall through the steps of labor. She laid out her birth options, including pain medications available to her and whether she wanted to delay umbilical cord clamping. If Marshall preferred, she could request only female or Black providers.

Pressing on Marshall’s lower back, King demonstrated ways her boyfriend could help relieve pain during labor. She wrapped Marshall in an African wrap called a kanga cloth, to help take some pressure off her stomach in the home stretch.

King turned on a Christian hypnobirthing playlist and gave Marshall a briefing on breastfeeding. 

“It’s about to be the hardest job you’ve ever done,” King said. “He’s never done this before. You’ve never done this before. So be graceful to yourself and give grace to him.”

Marshall is on Medicaid. While King is paid by Uzazi Village to be her doula, that wasn’t always the case. Over the years King, who was also on Medicaid when she had her first child, said she’s taken on clients outside the nonprofit who had no money to pay her but were clearly in need of support. 

One of the leading causes of pregnancy-related death in Missouri is linked to mental health. King said that while doctors can’t be in homes for postpartum visits, doulas can. And they’re watching for signs of depression, addiction and violence, all causes of death postpartum.

“Why continue to feed into doulas being a luxury and for those who can afford to pay out of pocket for them,” King said. “When in our Black communities and low-income communities, doulas are not a luxury, they are a necessity.” 

The movement to pay doulas has grown across the United States in recent years. According to the National Health Law Program’s Doula Medicaid Project, more than half the states either have Medicaid coverage for doulas or are working towards it.

“Doulas really do make a difference in birth outcomes,” said Hakima Payne, co-founder and CEO of Uzazi Village. “And lots of entities are benefiting off the efforts of doulas, and those are the entities that should be paying doulas.” 

Payne, who has worked in the birth space in Kansas City for decades, said it’s all too common for doulas to forgo a living wage to help a family in need. 

Thanks to a doula pilot program through the city of Kansas City, combined with scholarships through Uzazi Village, Payne said all her doulas are now paid about $25 an hour and can take on anyone as a client, regardless of insurance. But that’s not the norm everywhere. 

Okunsola Amadou knows many doulas who trade their pay for other family’s health. 

Amadou, the founder and CEO of Jamaa Birth Village based in Ferguson, the oldest community-based doula organization in the St. Louis region, said the going rate for doula services should be $1,500. Instead, many work on a sliding scale of affordability. 

This increases some access to care, but it also guarantees doulas are burning out. As many doulas as Jamaa Village has trained — more than 400 doulas since 2016, including in rural Missouri communities like Hickory County and the bootheel — Amadou said there’s still a huge need.

The Missouri bills garnered support this year from the American College of Obstetricians and Gynecologists and the Missouri Hospital Association. No one testified to the committee in opposition to the bills

“Doulas have shown me the light,” Shannon Cooper, a lobbyist for America’s Health Insurance Plans, said while testifying last month. “There is a spot for doula services in today’s health care world.” 

Missouri has no freestanding licensed birth centers 

Concerned after his local hospital between Columbia and Hannibal closed, Haden decided to spend part of last summer scoping out Missouri’s health care options.

More than 41% of counties in Missouri are designated maternity care deserts, higher than the national rate of 32%, according to a 2023 report from the March of Dimes. Across the state, 10% of women do not live within 30 minutes of a birthing hospital.

Haden’s trip included a tour of New Birth Company in Overland Park, Kansas, where he was surprised to learn about half the women opt for water births. He said the experience opened his eyes to a real fear “whether it’s founded or not,” of hospital births.

Others in the birth center space say the benefits of delivering low risk pregnancies outside of hospitals include a lowered risk for unnecessary medical intervention and an opportunity to labor more freely.

Lindsey Wilson is a certified nurse midwife who used to practice in rural Missouri. Now clinical director at New Birth Company, she said of the 3,000 babies they’re delivered in the past 14 years, about half are by mothers from Missouri.

“It is not uncommon for women to travel one to two hours easily in active labor in order to come to our birth center,” Wilson said. “And we’ve had car births because they cannot get to us quick enough, which is extremely unsafe.”

Cassaundra Jah, executive director of the National Association of Certified Professional Midwives, said birth centers and midwifery are about access. 

One of the best ways to fight health disparities is to have more culturally matched providers, she said. Enter midwifery, an occupation much more accessible to most than medical school.

A barrier she often sees to legislation promoting birth centers and midwives is fear by lawmakers for their constituents’ health. Jah said much of her work is focused on educating state leaders that midwives and birth centers only serve low risk pregnancies. They also have transfer agreements with local hospitals in case a birth turns into a medical emergency.

“Missourians do need the option of birth centers, especially since hospitals are closing and those high acuity services are further and farther between,” Payne said. “Birth centers can absolutely stand in the gap.”

As of 2021, there were more than 400 birth centers across the United States, according to the American Association of Birth Centers. Birth Center Equity, a group advocating for more diversity in birthing center spaces, has only identified 20 birth centers across the U.S. owned by people of color. 

Health professionals push to reduce congenital syphilis infections killing Missouri babies

Both Amadou at Jamaa Birth Village and Payne at Uzazi Village want to help grow that number. 

They plan to open birth centers in their prospective cities. Payne knows of others in rural Missouri hoping to do the same. If the “noxious” regulations aren’t eliminated, she said, they will only be able to serve women who can pay out of pocket, or through donors. 

Amadou, who is a certified professional midwife, plans to break ground on a birth center and postpartum retreat center this summer regardless of the legislation. But she hopes it doesn’t come to that.

“We know that hospitals are overwhelmed. They’re understaffed. Providers in the hospital are exhausted and doulas can only support so much,” Amadou said. “So we’re able to open a birthing center and also train additional midwives, additional Black midwives, in clinical care practices and we can really help to advance maternal health.”

Payne said when she started taking proposals for legislation around birth centers and doulas to lawmakers more than a decade ago, many of her ideas were considered radical. 

Not so much anymore. She’s hopeful this time, she’ll be heard.

“Missouri needs to make this happen. We’re ready for it; we are ripe for it,” Payne said. “And these things will matter. They will make a difference.”

State Sen. Mary Elizabeth Coleman presents her Senate-passed proposal to raise the threshold for passing constitutional amendments proposed by initiative petition to the House Elections and Elected Officials Committee on March 12, 2024 (Rudi Keller/Missouri Independent).

When Terrence Wise explains Missouri’s initiative petition process to his children, he brings up one particularly remarkable play by the Kansas City Chiefs.

The famous 13 second overtime win against the Buffalo Bills secured the Chiefs a place in the 2023 Super Bowl. As a result of the win, the NFL changed its overtime rules.

“That worked in our favor here in this Super Bowl this year, but that shouldn’t be the game we play when we talk about our democratic process,” Wise says he told his children, and then on Tuesday, Missouri lawmakers. “It should be majority rule and it should be fair and the winner should be the winner.”

Wise, with Stand Up KC, a group of low-wage workers who advocate for better pay and conditions in the Kansas City area, was among those who testified against a bill filed by state Sen. Mary Elizabeth Coleman, a Republican from Arnold, seeking to change Missouri’s citizen-led initiative petition process by making it more difficult to pass constitutional amendments.

The bill went before the House Committee on Elections and Elected Officials on Tuesday, one of the first pieces of Senate legislation to go before the House.

The legislation would require a statewide majority and majority vote in five of the state’s eight congressional districts to pass a constitutional amendment through the initiative petition process or a state convention. Right now, constitutional amendments just need a simple majority of 50% of the votes plus one.

The bill – Senate Joint Resolution 74 – remains a top priority for Missouri Republicans. 

While similar legislation has been introduced several times over the past few years, there’s renewed urgency this session as an initiative petition campaign seeking to legalize abortion up to the point of fetal viability continues to garner strong donor support.

In Missouri, all abortions are illegal except in the case of medical emergencies.

Coleman’s bill passed out of the Senate last month after Democrats filibustered for 21 hours, eventually scoring a win after Republicans agreed to remove so-called “ballot candy.” 

In addition to making it harder to enact constitutional amendments, the ballot candy would have asked voters if they want to bar non-citizens from voting and ban foreign entities from contributing to or sponsoring constitutional amendments. 

Democratic senators called the immigration and foreign entities provisions misleading and a sleight of hand meant to confuse voters from the issue at the heart of the amendment.  

Testifying Tuesday, Coleman asked representatives to return the ballot candy to the bill before passing it and sending it to the Senate for a final vote.

While lobbyists with Missouri Right to Life and Campaign for Life continue to testify in support of the bill, Coleman maintained the possibility of abortion landing on the November ballot isn’t her main motivator.

“People should have a voice, they should have a say. And that voice and that say should primarily be through their representative government whom they have a chance to throw out on our ears every two or four years,” Coleman said. “And they should have the ability to directly take something to the ballot, but we want to encourage people to make statutory changes and not constitutional changes.”

Asked if she’s confident the bill, if amended in the House, will pass once it’s back in the Senate, Coleman referred to a process called “previous question.”

Used to kill a filibuster, invoking the rarely-used rule allows the Senate to shut down debate and force a vote on legislation. 

Coleman on Tuesday said that while she and her Republican Senate colleagues opted out of using the rule to end a Senate filibuster last month, it remains in their back pocket when it comes time for a final vote.

As the Senate convened on Wednesday, Minority Leader John Rizzo of Independence and his fellow Democrats shut down any votes for the day, making a decision to filibuster after he learned Coleman threatened to invoke the previous question rule once back in the Senate.

“I have been through the movement of a previous question. It is mass chaos in here,” Rizzo said. “There are hard feelings that happen. People scream and yell at each other to the point where you are worried that people might come to blows.”

Rizzo said he hoped Wednesday’s filibuster would be an isolated event before returning to business as usual Thursday ahead of the legislature’s spring break. The Senate adjourned for the day after nearly two hours.

“Maybe we should’ve had course corrections before this,”Rizzo said Wednesday. “But the bottom line is we can do it today. We can do it now.”

State Rep. Tyson Smith, a Democrat from Columbia, on Tuesday called the bill an attempt to sabotage the initiative petition process and undermine majority rule.

In the past two election cycles, two ballot measures stemming from initiative petitions – Medicaid expansion and recreational marijuana legalization – have passed despite opposition from the GOP majority in the statehouse. Meanwhile, hundreds of other initiative petition campaigns failed to land on the ballot in the first place. 

Initiative petition campaigns are costly, in large part because of how many signatures are required to guarantee the measure makes it to the ballot. Groups are increasingly going through the process to amend the constitution in recent years because they are harder to overturn because a second statewide vote is required to undo any measure that passes.

Coleman and other lawmakers in support of the bill have maintained that changing the initiative petition process would give more voice to rural voters.

Republicans lawmakers have also argued that too many recent initiative petitions have been funded by out-of-state interest groups.

“It seems primarily to be a question of fundraising capability of those who are attempting to push it rather than the quality of the idea put forward when it comes to the initiative petition process,” Coleman said, pushing back on opinions that the initiative petition process is already difficult enough.

‘Uncharted territory’: How would abortion-rights amendment impact Missouri TRAP laws?

An analysis by The Independent found that by including the concurrent majority standard, as few as 23% of voters could defeat a ballot measure. This analysis looked at the majority in the four districts with the fewest number of voters in 2020 and 2022.

“It feels like we’re trying to fix something that ain’t broke,” said Amy Kuo Hammerman, with National Council of Jewish Women St. Louis, testifying in opposition.

Denise Lieberman, director of the Missouri Voter Protection Coalition, said the citizen initiative petition process is “the purest form of democratic participation.”

“When citizens are allowed to participate under the same ground rules as you all have, it advances our democracy, it encourages citizens to engage in conversations with one another, to talk and debate, to be participants,” she said. “And democracy functions better when that happens.” 

This story was updated at 2:50 p.m. Wednesday to include Senate Democrats’ response to Coleman’s statements during the House committee hearing.

(File photo by Getty Images).

Suzanne Alexander remembers vividly the reports of the St. Louis babies born with congenital syphilis. 

Blindness, deafness, developmental delays. 

Some were underweight. Others had problems with their bones. 

That’s if they survived.

Alexander, the bureau chief for communicable diseases with the City of St. Louis Department of Health and a member of a task force studying the causes of Missouri’s climbing congenital syphilis numbers, said in more than half the cases she has reviewed, an alarming trend stood out. 

The mothers of babies born with this infection hardly had prenatal care.

Health departments across the state and country have been sounding the alarms for the past few years as congenital syphilis cases rose and community health workers became overburdened.

From 2017 to 2021, congenital syphilis cases rose 219% across the country; in Missouri, they rose 593%, according to the Centers for Disease Control and Prevention. 

Between 2012 and 2015, one stillbirth from a congenital syphilis case was reported in Missouri. Since then, there’s been at least one infant death every year, with 18 deaths reported between 2016 and 2022, according to the Missouri Department of Health and Senior Services.

If detected early enough, the disease is reversible in the womb.

Two bills filed by Republicans in the House and Senate would put a system in place to catch more of these cases. The legislation comes as the state health department published another alert last week reporting that in 2022, Missouri recorded 81 congenital syphilis cases — the most in 30 years. 

“This is an eightfold increase in a preventable disease,” the advisory warned.

Right now, only two syphilis tests are required in pregnancy: one in the first trimester and one at birth. The legislation would add a third test at 28 weeks, when there is still time to treat the mother and baby. The bill would also require a third trimester test for HIV and hepatitis C and hepatitis B, which can cause liver damage in infants.

“We are sending the signal to providers that this is an incredibly important service,” Alexander said. “And they have the support of the legislature.”

What is congenital syphilis? 

A mother can pass along congenital syphilis in utero at any point in pregnancy.

For adults, the symptoms, if there are any, can include a rash on the palms of a person’s hands or on the soles of their feet, hair loss, swollen lymph nodes or sores. Often these symptoms go away on their own, though the disease remains.

If a mother is infected within four weeks of delivering their baby and doesn’t get treatment, the infant has a 40% chance of dying at birth or shortly after, according to the CDC.

“This bill is really about maternal and infant health, making sure that these mothers have the care that they need so that their babies can have the care that they need,” said state Rep. Melanie Stinnett, a Springfield Republican sponsoring the legislation who also helped pass postpartum Medicaid expansion last year.

Missouri bill would give custody of disputed embryos to person likeliest to create child

The testing could be done at a normal appointment and wouldn’t require an additional visit to the doctor. The cost would be covered by Medicaid. 

Stinnett, who has a background in health care serving as vice president of therapy services at The Ark of the Ozarks, a nonprofit for people with disabilities in Springfield, said she has high hopes the bill, which has garnered bipartisan support, will pass.

An identical bill was put forward by state Sen. Elaine Gannon, a Republican from De Soto. That bill got a committee hearing, but has not yet been voted on. 

“Healthy moms equal healthy babies,” Gannon said Wednesday before the Senate Health and Welfare Committee. “This is just another step we can take to ensure our most vulnerable population gets the health care they deserve.”

The American College of Obstetricians and Gynecologists and the Missouri Center for Public Health Excellence have testified in support of both bills.

Syphilis trends in Missouri

Dustin Hampton, bureau chief of HIV, STD and Hepatitis at the state health department, said in the past two years, he’s seen a shift in the populations most affected by syphilis. 

Most cases used to be in men who have sex with men in urban areas, Hampton said; thus, much of the health department’s education and messaging targeted this group for the past 15 years. But in recent years, the cases have shifted more to white, heterosexual people in rural areas. 

In most of the congenital cases they’ve seen, the woman either went to only one prenatal appointment, or none at all. 

“Many times the only care they received was when they were as they arrived at the hospital for delivery,” he said.

Hampton said the legislation will help identify cases faster, but it won’t prevent the spread of syphilis between sexual partners. 

“The populations that are experiencing syphilis increases now may not even be aware that they’re at risk for syphilis,” he said, adding that he’s heard many stories of women who didn’t know they had syphilis until the day their child was born.

Hampton said the health department started providing some of their testing sites with rapid syphilis tests, so patients can get results within 20 minutes rather than waiting a few days. The department also formed a statewide syphilis advisory group and they’re in the process of putting together a congenital syphilis review board. They’ve also helped double the number of disease intervention specialists at public health and county health agencies.

Treatment for syphilis during pregnancy requires three shots of Benzathine penicillin G spread one week apart. 

A recent investigation by ProPublica highlighted some shortages of the medication used to treat syphilis. 

Lisa Cox, a spokeswoman with the Missouri Department of Health and Senior Services, said the state has so far not experienced a shortage.  

“We have continued to regularly get shipments of Bicillin from our distributor,” Cox said. “We maintain an adequate supply of medication and have encouraged providers to utilize shared decision-making for all people they treat for syphilis.”

A crisis beyond STI testing

As lawmakers work on a legislative fix, local Missouri governments are confronting issues that run deeper than just lack of testing.

As Alexander reviewed cases in St. Louis, where there was an 11-fold increase in congenital syphilis cases between 2017 and 2021, she noticed how few women had prenatal care and how many had a history of substance abuse issues. 

“One of the difficulties in this tragedy is that not everyone screens for social determinants of health,” she said. “So we don’t know what supports a mother might need to have the capacity to pursue treatment.” 

The St. Louis Health Department is currently meeting with community-based organizations and those who’ve been diagnosed with syphilis to learn more about common barriers to prevention education and treatment. 

“There are very few success stories from ignoring the problem,” Alexander said. “We’re seeing the impact of lack of access, and we’re seeing the impact of not knowing what the disease looks like when you’ve been sick all your life, because we’ve never had good medical care.”

In St. Louis, the greatest increase has been in Black women. Stigma plays a role, Alexander said, as does lack of adequate sex education in schools so that partners would be more likely to use condoms.

“There is a genuine fear among women in general of being labeled ‘disease-ridden,’” she said. 

At the business session ahead of Thursday’s Kansas City Council meeting, Dr. Benjamin Grin, Chief Medical Officer with the Kansas City Health Department, said the issue isn’t that moms aren’t getting tested at appointments, it’s that they aren’t getting prenatal care in the first place.

He attributed this to social determinants of health including substance use disorder, housing insecurity, intimate partner violence and lack of transportation. Grin said they’ve also lost contact with mothers who have a positive diagnosis but then don’t come back for their full treatment. 

In Kansas City, there’s been a 221% increase in syphilis cases in women since 2017. Many of those women were of child-bearing age. As a result, the city has added five STD positions and two surveillance positions to the health department in the hopes of more efficient contact tracing, particularly after area sexual health clinics saw a decline in visits during the pandemic.

Tracy Russell, Executive Director at Nurture KC, said her non-profit, which serves about 300 pregnant and new mothers from the metro’s 14 poorest zip codes, said they also help educate families on safe sex practices. 

Russell said lack of knowledge of STIs continues to be an issue. Some families don’t know that STIs in pregnancy are possible, or that they can be infected but asymptomatic. 

“The message that always resonates the most with pregnant women is the impact on the baby,” Russell said. 

But it still doesn’t guarantee good access to medical care. Russell pointed to lack of trust in the medical system, particularly in communities of color. 

“You can’t underestimate that distrust of the system … not having enough providers who are from these communities is very problematic, too,” she said. “It’s all these issues that converge, and create these types of outcomes.”

Missouri Attorney General Andrew Bailey speaks Jan. 20, 2023, to the Missouri chapter of the Federalist Society on the Missouri House of Representatives dais (Annelise Hanshaw/Missouri Independent).

Missouri Attorney General Andrew Bailey filed a lawsuit Thursday against Planned Parenthood, relying on a staged, edited video from a right-wing group to accuse the organization of illegally transporting minors out of state for abortions.

The lawsuit is against Planned Parenthood Great Plains, which has clinics in the Kansas City region and Columbia.

Bailey is using as evidence a video filmed and edited by Project Veritas, a self-proclaimed conservative news organization founded in 2010 that often conducts undercover stings. Its now-ousted founder, James O’Keefe, is currently under investigation by New York authorities, and the organization has a long history of spreading claims that are later discredited.

In the video, a Kansas City area Planned Parenthood employee tells a man pretending to have a pregnant niece that she can help the 13-year-old get an abortion in Kansas without her parents’ knowledge.

“This lawsuit is the culmination of a multi-year campaign to drive Planned Parenthood from the State of Missouri because of its flagrant and intentional refusal to comply with state law,” Bailey wrote on social media. “ …It is time to eradicate Planned Parenthood once and for all to end this pattern of abhorrent, unethical, and illegal behavior.”

House Minority Leader Crystal Quade, a Springfield Democrat running for governor, said at a press conference Thursday that this is the latest in a series of “frivolous” lawsuits filed by Missouri attorneys general in recent years. Quade said she expects this lawsuit, like others, to ultimately be thrown out.

“Claiming that Planned Parenthood, who is a service provider who makes sure that our folks in the state of Missouri are healthy, are a part of a human trafficking ring or whatever he is saying at this point, is just ridiculous….” Quade said. “This is just another lawsuit just to try to get some headlines in an election year.”

Planned Parenthood calls video ‘doctored’

The video, posted in December by Project Veritas, shows a man pretending to be a concerned uncle asking a Planned Parenthood location in the Kansas City area about abortion services for a non-existent 13-year-old niece.

The man secretly taping the interaction for Project Veritas told the Planned Parenthood employees that the girl’s parents couldn’t know. Staff then directed him to their affiliates in Kansas where they said he could “bypass” parental consent.

The man then asks how often girls go out of state for abortions. The Planned Parenthood employee said it happens every day.

“Violating the ‘deeply rooted’ right of parents and the laws of Missouri, Planned Parenthood is inducing minors into making life-changing — and life-ending — decisions without parental consent,” the lawsuit reads.

Emily Wales, president and CEO of Planned Parenthood Great Plains, noted that Bailey tweeted about the lawsuit before it was officially filed in the courthouse.

“This is a press release dressed up as legal action from an unelected attorney general,” Wales said. “It is based on ‘evidence’ from fraudulent, extreme anti-abortion actors, who claim to be ‘journalists.’”

The lawsuit has not yet been scanned into the statewide court system, but a Boone County court clerk confirmed to The Independent that they received the lawsuit Thursday morning.

A Planned Parenthood spokesperson said the Project Veritas video was taken without staff’s knowledge, and was “heavily doctored and edited.”

They added that Planned Parenthood Great Plains does not provide any form of transportation directly to any patients, regardless of age or where they live.

“We will continue following state and federal laws,” Wales said. “And proudly providing Missourians with the compassionate sexual and reproductive care that remains available to them in a state with a total abortion ban.”

The lawsuit makes no reference to Kansas law, which states that physicians are required to have either parental consent or go through the judicial bypass process where a judge can authorize a minor to get an abortion without parental consent.

Under Missouri law, written before nearly all abortions became illegal in Missouri, no one can assist a minor in getting an abortion without the physician first having informed written consent of the minor and one parent or guardian, as long as the other parent or guardian has been notified in writing. However, parents do not have to give informed consent in cases where they victimized the child or are on a sex offender registry, for example.

‘We’re dealing with fiction’

Michael Wolff, a former Missouri Supreme Court chief justice and dean emeritus at St. Louis University School of Law, said his first question about the lawsuit is whether a fictional story is admissible in court.

Because in reality, he said, the lawsuit does not prove whether anyone has broken the law.

“So far we’re dealing with fiction,” Wolff said. “This is at base a highly political lawsuit and it’s very much presenting the courts with a hypothetical question. Courts don’t like to address hypothetical questions. They address real cases.”

He also asked whether the state has an interest in determining if children are forbidden from going across state lines for care, a right he said is granted to all U.S. citizens. Even though Missouri statute states a person can’t assist a child in obtaining an abortion, Wolff noted that every citizen has a right to travel interstate.

He added that if the fictional child got medical care in Kansas, there is nothing in the lawsuit that determines whether that care was in compliance with Kansas law.

Noting Bailey’s use of the word “trafficked,” Wolff said the politicized word jumps to the conclusion that this fictional child was being taken to Kansas against her will.

Bill blocking Medicaid money from going to Planned Parenthood advances in Missouri House

Wolff said the lawsuit is well-timed and well-placed for political purposes.

Bailey announced the lawsuit after taking heat from his opponent in the Republican attorney general primary, Will Scharf, who accused him of botching lawsuits against Planned Parenthood in the past.

“Andrew Bailey’s incompetence is hurting the pro-life cause in Missouri,” Scharf posted on social media last week, saying Bailey failed to effectively litigate a recent case in which the state Supreme Court sided with Planned Parenthood, ruling it was unconstitutional for the legislature to defund Planned Parenthood through the budget.

On Wednesday, the Missouri House pressed on with a new tactic, this time giving initial approval to a Republican-backed bill seeking to block Medicaid reimbursements to Planned Parenthood clinics in Missouri, which no longer provide abortions, but instead provide health care needs such as STI testing, contraceptives and cancer screenings.

The Project Veritas video has been used in defense of an identical bill in the Senate, sponsored by state Sens. Mary Elizabeth Coleman and Nick Schroer, both Republicans.

During a January Senate health and welfare committee hearing, Schroer told his colleagues the “very disturbing” video shows Planned Parenthood “diverting minors without parental consent.”

Jordon Weldon, who referred to Project Veritas as a collection of journalists, told senators the man in the video had posed as an uncle of a 13-year-old in need of an abortion.

State Sen. Barbara Washington, a Democrat from Kansas City, asked if either Weldon, who flew in to testify from New York, or the man who recorded the video, have journalism degrees.

Weldon, Project Veritas’ communications director, said they do not.

This story was updated at 3:35 p.m. to correct the spelling of Jordon Weldon’s name and to clarify her role with Project Veritas.

The exterior of a Planned Parenthood Reproductive Health Services Center on May 28, 2019 in St Louis (Michael B. Thomas/Getty Images).

A Republican-backed bill seeking to block Medicaid reimbursements to Planned Parenthood clinics in Missouri won initial approval in the state House Wednesday, despite pleas from Democrats to continue giving patients a broader choice of providers.

The bill, sponsored by state Rep. Cody Smith of Carthage, would make it illegal for any public funds, including Medicaid reimbursements, to go to abortion facilities or their affiliates, including Planned Parenthood. 

“This vote is a vote for life,” Smith told the House on Wednesday.

Blocking Planned Parenthood’s access to Medicaid money has been a goal of Republican lawmakers for years.  

But the idea took on newfound urgency this year as a faction of conservative state senators have vowed to block the normally routine renewal of a set of medical provider taxes — known as the federal reimbursement allowance, or FRA — that funnel billions into the Medicaid program unless it is coupled with restrictions on Planned Parenthood funding. 

The House hopes to send the bill to the Senate quickly in the hopes of breaking that logjam. 

The debate is taking place at at time when nearly every abortion is illegal in Missouri.

Since the U.S. Supreme Court overturned Roe v. Wade in June 2022, the Planned Parenthood clinics in Missouri have only provided services such as contraceptives, STI testing, cancer screenings and wellness checks. 

“I want to be really clear what this bill does,” said state Rep. Keri Ingle, a Democrat from Lee’s Summit. “It defunds health care clinics in the state of Missouri that are not providing abortions because they may be giving referrals to other clinics in different states.”

Republican lawmakers have argued that no state funds should be going to any organizations affiliated with abortion providers, or organizations that can help Missouri patients go out of state for abortions. 

Missouri’s Medicaid program, called MO HealthNet, serves low-income and disabled citizens, and has long banned funding for abortion, with limited exceptions. 

State Rep. Emily Weber, a Democrat from Kansas City, was among a few lawmakers who said during Wednesday’s debate that they’ve received reproductive health care at Planned Parenthood. 

Weber said Planned Parenthood became her main provider after she lost her job and her insurance years ago, but still needed regular testing after her doctor discovered she had  precancerous cervical cells.

“They are a great provider. They talked to me. They made sure I was comfortable,” Weber said. “This is the life-saving care that Planned Parenthood provides to Missourians each and every day.”

Smith said he hopes his bill marks “the final chapter in a relatively long and dramatic story that started here in the Missouri House.”

Missouri Republicans for nearly 50 years leading up to the overturning of Roe have been passing legislation to make it more difficult to open and operate abortion facilities in Missouri. Attempts to hamstring Planned parenthood did not end when abortion became illegal in the state. 

Lawmakers included a line in the state budget in 2022 stating Missouri could not spend any money on Medicaid-covered services if the provider or their affiliates also offered abortions. 

That attempt was ultimately struck down by the Missouri Supreme Court earlier this month when the judges for the second time in four years ruled it was unconstitutional for the legislature to defund Planned Parenthood through the budget.

Cole County Circuit Judge Jon Beetem ruled that efforts to “deny access to funds that are otherwise available to other MO HealthNet providers is ineffective and/or unconstitutional.” 

Planned Parenthood’s attorney in that case, Chuck Hatfield, argued in November that changing state law was the only constitutional way for the legislature to exclude a provider from the Medicaid program. 

Another bill aimed at defunding Planned Parenthood is moving through the Missouri Senate. That bill, identical to the one in the House, is sponsored by state Sens. Mary Elizabeth Coleman and Nick Schroer, both Republicans.

‘Uncharted territory’: How would abortion-rights amendment impact Missouri TRAP laws?